• Manish JaiswalEmail author


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.


Hydrocephalus CNS fungal infection Fungal meningitis Ventriculoperitoneal (VP) shunt CNS mycosis 



Amphotericin B colloidal dispersion


Amphotericin B lipid complex


Acquired immune deficiency syndrome


Central nervous system


Cerebrospinal fluid


Computed tomography


Fluid-attenuated inversion recovery


Glasgow Coma Scale


Human immunodeficiency virus


Intensive care unit


Magnetic resonance imaging

VP shunt

Ventriculoperitoneal shunt


  1. Baddley JW, Salzman D, Pappas PG. Fungal brain abscess in transplant recipients: epidemiologic, microbiologic, and clinical features. Clin Trans. 2002;16(6):419–24.Google Scholar
  2. Black KE, Baden LR. Fungal infections of the CNS: treatment strategies for the immunocompromised patient. CNS Drugs. 2007;21(4):293–318.PubMedGoogle Scholar
  3. 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.PubMedGoogle Scholar
  4. Casadevall A, Rosas AL, Nosanchuk JD. Melanin and virulence in Cryptococcus neoformans. Curr Opin Microbiol. 2000;3(4):354–8.PubMedGoogle Scholar
  5. Chakrabarti A, Sharma SC. Paranasal sinus mycoses. Indian J Chest Dis Allied Sci. 2000;42:293–304.PubMedGoogle Scholar
  6. 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.PubMedGoogle Scholar
  7. Chimelli L, Mahler-Araujo MB. Fungal infections. Brain Pathol. 1997;7(1):613–27.PubMedGoogle Scholar
  8. Chiou CC, Wong TT, Lin HH. Fungal infection of ventriculoperitoneal shunts in children. Clin Infect Dis. 1994;19:1049–53.PubMedGoogle Scholar
  9. 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.PubMedGoogle Scholar
  10. Diamond RD, Bennett JE. Prognostic factors in cryptococcal meningitis. Ann Intern Med. 1974;80:176–81.PubMedGoogle Scholar
  11. 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.PubMedGoogle Scholar
  12. 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.PubMedGoogle Scholar
  13. 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
  14. 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.PubMedPubMedCentralGoogle Scholar
  15. 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.PubMedGoogle Scholar
  16. 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.PubMedPubMedCentralGoogle Scholar
  17. Guarro J, Gene J. Opportunistic fusarial infections in humans. Eur J Clin Microbiol Infect Dis. 1995;14:74–54.Google Scholar
  18. 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.PubMedGoogle Scholar
  19. 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.PubMedGoogle Scholar
  20. 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.PubMedGoogle Scholar
  21. 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.PubMedGoogle Scholar
  22. 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.PubMedGoogle Scholar
  23. 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.PubMedGoogle Scholar
  24. Levitz SM. The ecology of Cryptococcus neoformans and the epidemiology of cryptococcosis. Rev Infect Dis. 1991;13:1164–9.Google Scholar
  25. Lu CH, Chang WN, Chang HW. The prognostic factors of cryptococcal meningitis in HIV-negative patients. J Hosp Infect. 1999;42:313–20.PubMedGoogle Scholar
  26. Middleton FG, Jurgenson PF, Utz JP, Shadomy S, Shadomy J. Brain abscess caused by Cladosporium trichoides. Ann Int Med. 1976;136:444–8.Google Scholar
  27. Moore CB, Sayers N, Mosquera J, Slaven J, Denning DW. Antifungal drug resistance in Aspergillus. J Infect. 2000;41(3):203–20.PubMedGoogle Scholar
  28. 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.PubMedPubMedCentralGoogle Scholar
  29. Nguyen MH, Yu VL. Meningitis caused by Candida species: an emerging problem in neurosurgical patients. Clin Infect Dis. 1995;21(2):323–7.PubMedGoogle Scholar
  30. 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.PubMedGoogle Scholar
  31. Pappas PG, Pottage JC, Powderly WG. Blastomycosis in patients with acquired immunodeficiency syndrome. Ann Intern Med. 1992;116:847–53.PubMedGoogle Scholar
  32. Park MK, Hospenthal DR, Bennett JE. Treatment of hydrocephalus secondary to cryptococcal meningitis by use of shunting. Clin Infect Dis. 1999;28:629–33.PubMedGoogle Scholar
  33. 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.PubMedGoogle Scholar
  34. 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.PubMedGoogle Scholar
  35. Revankar SG, Sutton DA, Rinaldi MG. Primary central nervous system phaeohyphomycosis: a review of 101 cases. Clin Infect Dis. 2004;38(2):206–16.PubMedGoogle Scholar
  36. 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.PubMedGoogle Scholar
  37. 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.Google Scholar
  38. 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.PubMedGoogle Scholar
  39. Singh N, Husain S. Infections of the central nervous system in transplant recipients. Transpl Infect Dis. 2001;2:101–11.Google Scholar
  40. 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.PubMedGoogle Scholar
  41. Tang LM. Ventriculoperitoneal shunt in cryptococcal meningitis with hydrocephalus. Surg Neurol. 1990;33:314–9.PubMedGoogle Scholar
  42. Treseler CB, Sugar AM. Fungal meningitis. Infect Dis Clin N Am. 1990;4(4):789–808.Google Scholar
  43. Venger BH, Landon G, Rose JE. Solitary Histoplasmoma of the thalamus: case report and literature review. Neurosurgery. 1987;20(5):784–7.PubMedGoogle Scholar
  44. Verma A, Brozman B, Petito CK. Isolated cerebral mucormycosis: report of a case and review of literature. J Neurol Sci. 2006;240:65–9.PubMedGoogle Scholar
  45. Wheat LJ, Batteiger BE, Sathapatayavongs B. Histoplasma capsulatum infections of the central nervous system, a clinical review. Medicine. 1990;69:244–60.PubMedGoogle Scholar
  46. Wright D, Schneider A, Berger JR. Central nervous system opportunistic infections. Neuroimaging Clin N Am. 1997;7(3):513–25.PubMedGoogle Scholar
  47. Zarei Mahmoudabadi A. Antifungal drugs. Iran: Vasef; 2002. p. 102–6.Google Scholar
  48. 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
  49. 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
  50. Zarrin M, Zarei Mahmoudabadi A. Invasive candidiasis; a review article. Jundishapur J Microbiol. 2009;2(1):1–6.Google Scholar
  51. 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
  52. 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

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of NeurosurgeryKing George’s Medical UniversityLucknowIndia

Personalised recommendations