Ventriculoperitoneal shunts for treating increased intracranial pressure in cryptococcal meningitis with or without ventriculomegaly

• Main Authors: Marcelo Corti, Maria Priarone, Ricardo Negroni, Leonardo Gilardi, Jimena Castrelo, Alicia Irene Arechayala, Fernando Messina, Osvaldo Franze
• Format: Article
• Language: English
• Published: Sociedade Brasileira de Medicina Tropical (SBMT) 2014-07-01
• Series: Revista da Sociedade Brasileira de Medicina Tropical
• Subjects: Cryptococcus neoformans; Cryptococcal meningitis; Intracranial hypertension; Ventriculoperitoneal shunts
• Online Access: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0037-86822014000400524&lng=en&tlng=en
• ISSN: 1678-9849

Introduction Cryptococcosis is an opportunistic mycosis, especially in patients that are human immunodeficiency virus (HIV)-positive, and frequently involves the central nervous system. Methods We assessed the potential of ventriculoperitoneal shunting (VPS) in preventing mortality due to uncontrollable intracranial hypertension (ICH) in 15 patients with acquired immunodeficiency syndrome (AIDS)-related cryptococcal meningitis. Results After 2 weeks of antifungal therapy consisting of amphotericin B deoxycholate with or without fluconazole, patients with persistent ICH underwent VPS, despite having persistent Cryptococcus neoformans infection. In 12 patients, the uncontrollable ICH was resolved by VPS. Conclusions Patients with cryptococcal meningoencephalitis who have ICH must be considered for VPS even with positive cerebrospinal fluid cultures.