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Fungal Infections of the Central Nervous System pp 259–267Cite as

Hydrocephalus

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Abstract

Hydrocephalus is an occasional complication of fungal meningitis. The frequency of hydrocephalus varies in different studies. As previous studies have shown, hydrocephalus secondary to fungal meningitis occurs in 9–63% of patients. Delays in the diagnosis and treatment of hydrocephalus are directly related to poor outcome, including various degrees of residual neurological consequences. Various neurological manifestations, including headache, vomiting, visual impairment, mental change, gait ataxia, and deterioration of consciousness, may be associated with progressive hydrocephalus. These may be attributed to the infection itself, to hydrocephalus, or to both. These clinical findings are of little help in establishing the presence of hydrocephalus. However, the presence of headache, visual impairment, mental change, gait ataxia, and deterioration of consciousness should raise the suspicion that hydrocephalus is present. Brain computed tomography and magnetic resonance imaging are useful tools for rapid diagnosis of hydrocephalus. The treatment of patients with fungal meningitis complicated with hydrocephalus is essentially a diversion of ventricular cerebrospinal fluid (CSF) through a ventriculoperitoneal (VP) shunt or external ventricular drainage. The indications and timing for placement of a shunt in patients with fungal meningitis complicating hydrocephalus are not well understood or universally accepted. Most authors suggest early shunt placement for hydrocephalus to avoid irreversible neurological complications. However, in some patients with fungal meningitis and hydrocephalus, diversion of CSF through a VP shunt does not result in any significant improvement. Thus, selecting patients who would benefit from a VP shunt becomes important because use of VP shunts does not result in a good response or outcome if it is associated with a Glasgow Coma Scale score of 8 and below and duration of altered consciousness of more than 48 hours.

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Abbreviations

ABCD:

Amphotericin B colloidal dispersion

ABLC:

Amphotericin B lipid complex

AIDS:

Acquired immune deficiency syndrome

CNS:

Central nervous system

CSF:

Cerebrospinal fluid

CT:

Computed tomography

FLAIR:

Fluid-attenuated inversion recovery

GCS:

Glasgow Coma Scale

HIV:

Human immunodeficiency virus

ICU:

Intensive care unit

MRI:

Magnetic resonance imaging

VP shunt:

Ventriculoperitoneal shunt

References

  • Baddley JW, Salzman D, Pappas PG. Fungal brain abscess in transplant recipients: epidemiologic, microbiologic, and clinical features. Clin Trans. 2002;16(6):419–24.

    Article  Google Scholar 

  • Black KE, Baden LR. Fungal infections of the CNS: treatment strategies for the immunocompromised patient. CNS Drugs. 2007;21(4):293–318.

    Article  CAS  PubMed  Google Scholar 

  • Borha A, Parienti JJ, Emery E, Coskun O, Khouri S, Derlon JM. Candida albicans cerebral granuloma in an immunocompetent patient. A case report. Neurochirurgie. 2009;55(1):57–62.

    Article  CAS  PubMed  Google Scholar 

  • Casadevall A, Rosas AL, Nosanchuk JD. Melanin and virulence in Cryptococcus neoformans. Curr Opin Microbiol. 2000;3(4):354–8.

    Article  CAS  PubMed  Google Scholar 

  • Chakrabarti A, Sharma SC. Paranasal sinus mycoses. Indian J Chest Dis Allied Sci. 2000;42:293–304.

    CAS  PubMed  Google Scholar 

  • Chakrabarti A, Das A, Mandal J. The rising trend of invasive zygomycosis in patients with uncontrolled diabetes mellitus. Med Mycol. 2006;44(4):335–42.

    Article  PubMed  Google Scholar 

  • Chimelli L, Mahler-Araujo MB. Fungal infections. Brain Pathol. 1997;7(1):613–27.

    Article  CAS  PubMed  Google Scholar 

  • Chiou CC, Wong TT, Lin HH. Fungal infection of ventriculoperitoneal shunts in children. Clin Infect Dis. 1994;19:1049–53.

    Article  CAS  PubMed  Google Scholar 

  • Cruciani M, Di Perri G, Molesini M, Vento S, Concia E, Bassetti D. Use of fluconazole in the treatment of Candida albicans hydrocephalus shunt infection. Eur J Clin Microbiol Infect Dis. 1992;11:957.

    Article  CAS  PubMed  Google Scholar 

  • Diamond RD, Bennett JE. Prognostic factors in cryptococcal meningitis. Ann Intern Med. 1974;80:176–81.

    Article  CAS  PubMed  Google Scholar 

  • Dotis J, Iosifidis E, Roilides E. Central nervous system aspergillosis in children: a systematic review of reported cases. Int J Infect Dis. 2007;11(5):381–93.

    Article  PubMed  Google Scholar 

  • Dubey A, Patwardhan RV, Sampth S, Santosh V, Kolluri S, Nanda A. Intracranial fungal granuloma: analysis of 40 patients and review of the literature. Surg Neurol. 2005;63(3):254–60.

    Article  PubMed  Google Scholar 

  • Dupont B. Fungal infections of the central nervous system. In: Anaissie EJ, McGinnis MR, Pfaller MA, editors. Clinical mycology. 1st ed. New York: Churchill Livinstone; 2003. p. 539–53.

    Google Scholar 

  • Feng B, Wang X, Hauser M. Molecular cloning and characterization of WdPKS1, a gene involved in dihydroxynaphthalene melanin biosynthesis and virulence in Wangiella (Exophiala) dermatitidis. Infect Immun. 2001;69(3):1781–94.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Fessler RD, Sobel J, Guyot L. Management of elevated intracranial pressure in patients with cryptococcal meningitis. J Acquir Immune Defic Syndr Hum Retrovirol. 1998;17:137–42.

    Article  CAS  PubMed  Google Scholar 

  • Genzen JR, Kenney B. Central nervous system Aspergillus infection after epidural analgesia: diagnosis, therapeutic challenges, and literature review. Diagn Microbiol Infect Dis. 2009;65(3):312–8.

    Article  PubMed  PubMed Central  Google Scholar 

  • Guarro J, Gene J. Opportunistic fusarial infections in humans. Eur J Clin Microbiol Infect Dis. 1995;14:74–54.

    Google Scholar 

  • Hardesty DA, Ramey W, Afrasiabi M a, Beck B, Gonzalez O, Moran A, Nakaji P. Patient outcomes and surgical complications in coccidioidomycosis-related hydrocephalus: an institutional review. J Neurosurg. 2014;121:785–9.

    Article  PubMed  Google Scholar 

  • Ito-Kuwa S, Nakamura K, Valderrama B, Aoki S, Vidotto V, Osafune T. Diversity of laccase among Cryptococcus neoformans serotypes. Microbiol Immunol. 2008;52(10):492–8.

    Article  CAS  PubMed  Google Scholar 

  • Jellinger KA, Setinek U, Drlicek M, Böhm G, Steurer A, Lintner F. Neuropathology and general autopsy findings in AIDS during the last 15 years. Acta Neuropathol. 2000;100(2):213 20.

    Article  PubMed  Google Scholar 

  • Kantarcioglu AS, de Hoog GS. Infections of the central nervous system by melanised fungi: a review of cases presented between 1999 and 2004. Mycoses. 2004;47(1-2):4–13.

    Article  CAS  PubMed  Google Scholar 

  • Kedziora K, Słomiński JM, Gil K, Porzezińska M, Gorzewska A. Invasive aspergillosis of the paranasal sinuses, lung and brain. Pneumonol Alergol Pol. 2008;76(5):400–6.

    PubMed  Google Scholar 

  • Kovoor JM, Mahadevan A, Narayan JP. Cryptococcal choroid plexitis as a mass lesion: MR imaging and histopathologic correlation. AJNR Am J Neuroradiol. 2002;23(2):273–6.

    PubMed  Google Scholar 

  • Levitz SM. The ecology of Cryptococcus neoformans and the epidemiology of cryptococcosis. Rev Infect Dis. 1991;13:1164–9.

    Article  Google Scholar 

  • Lu CH, Chang WN, Chang HW. The prognostic factors of cryptococcal meningitis in HIV-negative patients. J Hosp Infect. 1999;42:313–20.

    Article  CAS  PubMed  Google Scholar 

  • Middleton FG, Jurgenson PF, Utz JP, Shadomy S, Shadomy J. Brain abscess caused by Cladosporium trichoides. Ann Int Med. 1976;136:444–8.

    Article  CAS  Google Scholar 

  • Moore CB, Sayers N, Mosquera J, Slaven J, Denning DW. Antifungal drug resistance in Aspergillus. J Infect. 2000;41(3):203–20.

    Article  CAS  PubMed  Google Scholar 

  • Nakouzi A, Zhang T, Oscarson S, Casadevall A. The common Cryptococcus neoformans glucuronoxylomannan M2 motif elicits non-protective antibodies. Vaccine. 2009;27(27):3513–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Nguyen MH, Yu VL. Meningitis caused by Candida species: an emerging problem in neurosurgical patients. Clin Infect Dis. 1995;21(2):323–7.

    Article  CAS  PubMed  Google Scholar 

  • Pagano L, Ricci P, Tonso A. Mucormycosis in patients with haematological malignancies: a retrospective clinical study of 37 cases. Br J Haematol. 1997;99(2):331–6.

    Article  CAS  PubMed  Google Scholar 

  • Pappas PG, Pottage JC, Powderly WG. Blastomycosis in patients with acquired immunodeficiency syndrome. Ann Intern Med. 1992;116:847–53.

    Article  CAS  PubMed  Google Scholar 

  • Park MK, Hospenthal DR, Bennett JE. Treatment of hydrocephalus secondary to cryptococcal meningitis by use of shunting. Clin Infect Dis. 1999;28:629–33.

    Article  CAS  PubMed  Google Scholar 

  • Pitisuttithum P, Negroni R, Graybill JR. Activity of posaconazole in the treatment of central nervous system fungal infections. J Antimicrob Chemother. 2005;56(4):745–55.

    Article  CAS  PubMed  Google Scholar 

  • Redmond A, Dancer C, Woods ML. Fungal infections of the central nervous system: a review of fungal pathogens and treatment. Neurol India. 2007;55:251–9.

    Article  PubMed  Google Scholar 

  • Revankar SG, Sutton DA, Rinaldi MG. Primary central nervous system phaeohyphomycosis: a review of 101 cases. Clin Infect Dis. 2004;38(2):206–16.

    Article  PubMed  Google Scholar 

  • Ribaud P, Chastang C, Latgé JP. Survival and prognostic factors of invasive aspergillosis after allogeneic bone marrow transplantation. Clin Infect Dis. 1999;28(2):322–30.

    Article  CAS  PubMed  Google Scholar 

  • Sanchez-Portocarrero JP, Saldan CJ, Perzececilia E. Candida cerebrospinal fluid shunt infections: report of two cases and review of literature. Diag Microbiol Infect Dis. 1994;20:33–40.

    Article  CAS  Google Scholar 

  • Shankar SK, Mahadevan A, Sundaram C. Pathobiology of fungal infections of the central nervous system with special reference to the Indian scenario. Neurol India. 2007;55:198–215.

    Article  CAS  PubMed  Google Scholar 

  • Singh N, Husain S. Infections of the central nervous system in transplant recipients. Transpl Infect Dis. 2001;2:101–11.

    Article  Google Scholar 

  • Speed B, Dunt D. Clinical and host differences between infections with the two varieties of Cryptococcus neoformans. Clin Infect Dis. 1995;21(1):28–36.

    Article  CAS  PubMed  Google Scholar 

  • Tang LM. Ventriculoperitoneal shunt in cryptococcal meningitis with hydrocephalus. Surg Neurol. 1990;33:314–9.

    Article  CAS  PubMed  Google Scholar 

  • Treseler CB, Sugar AM. Fungal meningitis. Infect Dis Clin N Am. 1990;4(4):789–808.

    CAS  Google Scholar 

  • Venger BH, Landon G, Rose JE. Solitary Histoplasmoma of the thalamus: case report and literature review. Neurosurgery. 1987;20(5):784–7.

    Article  CAS  PubMed  Google Scholar 

  • Verma A, Brozman B, Petito CK. Isolated cerebral mucormycosis: report of a case and review of literature. J Neurol Sci. 2006;240:65–9.

    Article  PubMed  Google Scholar 

  • Wheat LJ, Batteiger BE, Sathapatayavongs B. Histoplasma capsulatum infections of the central nervous system, a clinical review. Medicine. 1990;69:244–60.

    Article  CAS  PubMed  Google Scholar 

  • Wright D, Schneider A, Berger JR. Central nervous system opportunistic infections. Neuroimaging Clin N Am. 1997;7(3):513–25.

    CAS  PubMed  Google Scholar 

  • Zarei Mahmoudabadi A. Antifungal drugs. Iran: Vasef; 2002. p. 102–6.

    Google Scholar 

  • Zarei Mahmoudabadi A, Farrahei F, Zarrin M. In vitro synergism between miconazole and griseofulvin against Candida species. Pak J Med Sci. 2006;22(4):454–6.

    Google Scholar 

  • Zarrin M, Najafi M. In vitro activities of amphotericin B in combination with rifampin against Aspergillus species. Pak J Med Sci. 2007;23(3):323–5.

    Google Scholar 

  • Zarrin M, Zarei Mahmoudabadi A. Invasive candidiasis; a review article. Jundishapur J Microbiol. 2009;2(1):1–6.

    Google Scholar 

  • Zarrin M, Jamshidian M, Jafari M. In vitro interactions of miconazole with sulfametoxazole against Candida species. Pak J Med Sci. 2009;25:243–6.

    Google Scholar 

  • Zarrin M, Jorfi M, Aamirrajab N, Rostami M. Isolation of Cryptococcus neoformans from pigeon droppings in Ahwaz, Iran. Turk J Med Sci. 2010;40(1):313–6.

    Google Scholar 

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Authors and Affiliations

  1. Department of Neurosurgery, King George’s Medical University, Lucknow, Uttar Pradesh, India

    Manish Jaiswal

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  1. Manish Jaiswal
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Correspondence to Manish Jaiswal .

Editor information

Editors and Affiliations

  1. Department of Neurosurgery, Aydın Adnan Menderes University, School of Medicine, Aydın, Turkey

    Mehmet Turgut

  2. Department of Pathology, Basavatarakam Indo-American Hospital & Research Institute, Hyderabad, Telangana, India

    Sundaram Challa

  3. Department of Neurosurgery, Avicenne Military Hospital, Mohammed V University in Rabat, Marrakech, Morocco

    Ali Akhaddar

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Jaiswal, M. (2019). Hydrocephalus. In: Turgut, M., Challa, S., Akhaddar, A. (eds) Fungal Infections of the Central Nervous System. Springer, Cham. https://doi.org/10.1007/978-3-030-06088-6_19

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  • DOI: https://doi.org/10.1007/978-3-030-06088-6_19

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