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Cryptococcal meningitis in the immunocompromised host: intracranial hypertension and other complications

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Abstract

Cryptococcosis as a complication of the immunocompromised host has dramatically increased in frequency since the start of the AIDS epidemic. This trend has heightened awareness of the complications of cryptococcal meningitis; of these, intracranial hypertension is common, severe, and life-threatening, as exemplified by three cases in our institutions presented here in detail. An aggressive approach to management of this complication has not been the standard of care, but neurosurgical interventional studies combined with physiologic observations suggest early intervention may reduce the devastating morbidity and mortality.

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References

  1. Kwon-Chung KJ, Bennett JE, eds. Cryptococcosis. In: Medical Mycology. Philadelphia: Lea and Febiger, 1992: 397–446.

    Google Scholar 

  2. Zimmerman LE, Rappaport H. Occurrence of cryptococcosis in patients with malignant disease of reticuloendothelial system. Am J Clin Pathol 1954; 24: 1050–1072.

    PubMed  CAS  Google Scholar 

  3. Kaplan MH, Rosen PP, Armstrong D. Cryptococcosis in a cancer hospital. Clinical and pathologic correlates in 46 patients. Cancer 1977; 39: 2265–2274.

    Article  PubMed  CAS  Google Scholar 

  4. Diamond RD. Cryptococcus neoformans. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases, 4th ed. New York: Churchill Livingstone, 2331–2340.

  5. Hadley S, Karchmer AW. Fungal infections in solid organ transplant recipients. Infect Dis Clin North Am 1995; 9: 1045–1075.

    PubMed  CAS  Google Scholar 

  6. Jabbour N, Reyes J, Kusne S, Martin M, Fung J. Cryptococcal meningitis after liver transplantation. Transplant 1996; 61: 146–167.

    Article  CAS  Google Scholar 

  7. Rubin RH, Hooper DC. Central nervous system infection in the compromised host. Med Clin North Am 1985; 69: 281–297.

    PubMed  CAS  Google Scholar 

  8. Mitchell TG, Perfect JR. Cryptococcosis in the era of AIDS: 100 years after the discovery of Cryptococcus neoformans. Clin Microbiol Rev 1995; 8: 515–548.

    PubMed  CAS  Google Scholar 

  9. Saag MS, Powderly WG, Cloud GA, Robinson P, Grieco MH, Sharkey PK, Thompson SE, Sugar AM, Tuazon CU, Fisher JF, Hyslop N, Jacobson JM, Hather R, Dismukes WE, and the NIAID Mycoses Study Group and the AIDS Clinical Trials Group. Comparison of amphotericin B with fluconazole in the treatment of acute AIDS-associated cryptococcal meningitis. N Engl J Med 1992; 326: 83–89.

    Article  PubMed  CAS  Google Scholar 

  10. Stevens DA Itraconazole in cyclodextrin solution. Pharmacother 1999; 19: 603–611.

    Article  CAS  Google Scholar 

  11. Van der Horst CM, Saag MS, Cloud GA, Hamill RJ, Graybill JR, Sobel JD, Johnson PC, Tuazon CU, Kerkering T, Moskovitz BL, Powderly WG, Dismukes WE, and the NIAID Mycoses Study Group and AIDS Clinical Trials Group. Treatment of cryptococcal meningitis associated with the acquired immunodeficiency syndrome. N Engl JMed 1997; 337: 15–21.

    Article  CAS  Google Scholar 

  12. Sharkey PK, Graybill JR, Johnson ES, Hausrath SG, Pollard RB, Kolokathis A, Mildvan D, Fan-Havard P, Eng RHK, Patterson TF, Pottage JC, Simberkoff MS, Wolf J, Meyer RD, Gupta R, Lee LW, Gordon DS. Amphotericin B lipid complex compared with amphotericin B in the treatment of cryptococcal meningitis in patients with AIDS. Clin Infect Dis 1996; 22: 315–321.

    PubMed  CAS  Google Scholar 

  13. Clemons KV, Stevens DA. Comparison of Fungizone, Amphotec, AmBisome, and Abelcet for treatment of systemic murine cryptococcosis. Antimicrob Agents Chemother 1998; 42: 899–902.

    Google Scholar 

  14. Graybill JR, Sobel J, Saag M, van der Horst C, Powderly W, Cloud G and the NIAID Mycoses Study Group and the AIDS Clinical Trials Group. Cerebrospinal fluid (CSF) hypertension in patients with AIDS and cryptococcal meningitis (CM) (abstract). Interscience Conference on Antimicrobial Agents and Chemotherapy 1997: 271.

  15. Malessa R, Krams M, Hengge U, Weiller C, Reinhardt V, Volbracht L, Rauhut F, Brockmeyer NH. Elevation of intracranial pressure in acute AIDS-related cryptococcal meningitis. Clin Invest 1994; 72: 1020–1026.

    Article  CAS  Google Scholar 

  16. Tang L-M. Ventriculoperitoneal shunt in cryptococcal meningitis with hydrocephalus. Surg Neurol 1990; 33: 314–319.

    Article  PubMed  CAS  Google Scholar 

  17. Denning DW, Armstrong RW, Lewis BH, Stevens DA. Elevated cerebrospinal fluid pressures in patients with cryptococcal meningitis and acquired immunodeficiency syndrome. Am J. Med 1991; 91: 267–272.

    Article  PubMed  CAS  Google Scholar 

  18. Rex JH, Larsen RA, Dismukes WE, Cloud GA, Bennett JE. Catastrophic visual loss due to Cryptococcus neoformans meningitis. Medicine 1993; 72: 207–224.

    PubMed  CAS  Google Scholar 

  19. Okun E, Butler WT. Ophthalmologic complications of cryptococcal meningitis. Arch Ophthalmol 1964; 71: 52–55

    PubMed  CAS  Google Scholar 

  20. Seaton RA, Verma N, Naraqi S, Wembri JP, Warrell D. Visual loss in immunocompetent patients with Cryptococcus neoformans var. gatti meninitis. Trans Royal Soc Trop Med 1997; 91: 44–49.

    Article  CAS  Google Scholar 

  21. Seaton RA, Verma N, Naraqi S, Wembri JP, Warrell D. The effect of corticosteroids on visual loss in Cryptococcus neoformans var. gatti meningitis. Trans Royal Soc Trop Med Hyg 1997; 91: 50–52.

    Article  CAS  Google Scholar 

  22. Bingaman WE, Frank JI Malignant cerebral edema and intracranial hypertension. Neurol Clinics 1995;13:479–509.

    CAS  Google Scholar 

  23. Borgbjerg BM, Gjerris F, Albeck MJ, Borgesen SE. Risk of infection after cerebrospinal fluid shunt: An analysis of 884 first-time shunts. Acta Neurochir 1995; 136: 1–7.

    Article  CAS  Google Scholar 

  24. Borgbjerg BM, Gjerris F, Albeck MJ, Hauerberg J, Borgesen SE. Frequency and causes of shunt revisions in different cerebrospinal fluid shunt types. Acta Neurochir 1995; 136: 189–194.

    Article  CAS  Google Scholar 

  25. Park MK, Hospenthal DR, Bennett JE. Treatment of hydrocephalus secondary to cryptococcal meningitis by use of shunting. Clin Infect Dis 1999; 8: 629–633.

    Google Scholar 

  26. Imberti R, Bellinzona G, Ilardi M, Bruzzone P, Pricca P. The use of indomethacin to treat acute rises of intracranial pressure and improve global cerebral perfusion in a child with head trauma. Acta Anaesthesiol Scand 1997; 41: 536–540.

    PubMed  CAS  Google Scholar 

  27. Fessler RD Sobel J, Guyot, L, Crane L, Vazquez J, Szuba MJ, Diaz FG. Management of elevated intracranial pressure in patients with cryptococcal meningitis. J Acquired Immunodeficiency Syndromes Human Retrovirol. 1998; 17: 137–142.

    CAS  Google Scholar 

  28. Bach MC, Tally PW, Godofsky EW. Use of cerebrospinal fluid shunts in patients having acquired immunodeficiency syndrome with cryptococcal meningitis and uncontrollable intracranial hypertension. Neurosurg 1997; 41: 1280–1283.

    Article  CAS  Google Scholar 

  29. Mylonakis E, Merriman NA, Rich JD, Flanigan TP, Walters BC, Tashima KT, Mileno MD, Van der Horst CM. Use of cerebrospinal fluid shunt for the management of elevated intracranial pressure in patient with active AIDS-related cryptococcal meningitis. Diag Microbiol Infect Dis 1999; 34: 111–114.

    Article  CAS  Google Scholar 

  30. Pickard JD, Czosnyka M. Management of raised intracranial pressure. J Neurol. Neurosurg Pschiatr 1993; 56: 845–858.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Medicine, Division of Infectious Diseases, Santa Clara Valley Medical Center, San Jose, CA, USA

    David A. Stevens, Robert W. Armstrong & Jacqueline D. Adler

  2. Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA

    David A. Stevens, Robert W. Armstrong & Jacqueline D. Adler

  3. California Institute for Medical Research, San Jose, CA, USA

    David A. Stevens & Jacqueline D. Adler

  4. Department of Infectious Diseases and Tropical Medicine, North Manchester General Hospital and Section of Infectious Diseases, University of Manchester, Hope Hospital, Manchester, England, UK

    David W. Denning

  5. Department of Neurosurgery, Santa Clara Valley Medical Center and, Stanford University School of Medicine, CA, USA

    Stanley Shatsky

  6. Department of Medicine, Good Samaritan Hospital, Los Gatos, CA, USA

    Robert W. Armstrong

  7. Comprehensive Cancer Center and the Adult Hemophilia Program, Alta Bates Hospital, Berkeley, CA, USA

    Bradley H. Lewis

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  1. David A. Stevens
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  2. David W. Denning
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  3. Stanley Shatsky
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  4. Robert W. Armstrong
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  5. Jacqueline D. Adler
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  6. Bradley H. Lewis
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Stevens, D.A., Denning, D.W., Shatsky, S. et al. Cryptococcal meningitis in the immunocompromised host: intracranial hypertension and other complications. Mycopathologia 146, 1–8 (1999). https://doi.org/10.1023/A:1007031514495

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  • DOI: https://doi.org/10.1023/A:1007031514495

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