1921
Volume 97, Issue 5
  • ISSN: 0002-9637
  • E-ISSN: 1476-1645

Abstract

Abstract.

Cryptococcal meningitis may have long-term morbidity and requires a permanent cerebrospinal fluid shunt. This study aimed to evaluate the risk factors and create a predictive model for permanent shunt treatment in cryptococcal meningitis patients. This was a retrospective analytical study conducted at Khon Kaen University. The study period was from January 2005 to December 2015. We enrolled all adult patients diagnosed with cryptococcal meningitis. Risk factors predictive for permanent shunting treatment were analyzed by multivariate logistic regression analysis. There were 341 patients diagnosed with cryptococcal meningitis. Of those, 64 patients (18.7%) were treated with permanent shunts. There were three independent factors associated with permanent shunt treatment. The presence of hydrocephalus had the highest adjusted odds ratio at 56.77. The resulting predictive model for permanent shunt treatment (y) is (−3.85) + (4.04 × hydrocephalus) + (2.13 × initial cerebrospinal fluid (CSF) opening pressure (OP) > 25 cm HO) + (1.87 × non-human immune deficiency vrus (HIV)). In conclusion, non-HIV status, initial CSF OP greater than or equal to 25 cm HO, and the presence of hydrocephalus are indicators of the future necessity for permanent shunt therapy.

Loading

Article metrics loading...

The graphs shown below represent data from March 2017
/content/journals/10.4269/ajtmh.17-0177
2017-11-08
2019-03-22
Loading full text...

Full text loading...

/deliver/fulltext/14761645/97/5/tpmd170177.html?itemId=/content/journals/10.4269/ajtmh.17-0177&mimeType=html&fmt=ahah

References

  1. Pukkila-Worley R, Mylonakis E, , 2008. Epidemiology and management of cryptococcal meningitis: developments and challenges. Expert Opin Pharmacother 9: 551560.[Crossref] [Google Scholar]
  2. Pappas PG, , 2013. Cryptococcal infections in non-HIV-infected patients. Trans Am Clin Climatol Assoc 124: 6179. [Google Scholar]
  3. Petrou P, Moscovici S, Leker RR, Itshayek E, Gomori JM, Cohen JE, , 2012. Ventriculoperitoneal shunt for intracranial hypertension in cryptococcal meningitis without hydrocephalus. J Clin Neurosci 19: 11751176.[Crossref] [Google Scholar]
  4. Luo FL, Tao YH, Wang YM, Li H, , 2015. Clinical study of 23 pediatric patients with cryptococcosis. Eur Rev Med Pharmacol Sci 19: 38013810. [Google Scholar]
  5. Tunlayadechanont S, Viranuvatti K, Phuapradit P, Sathapatayavong B, Tantirittisak T, Boongird P, , 1997. Cryptococcal meningitis in patients with non-HIV and HIV infection: a clinical study. Neurol J Southeast Asia 2: 4550. [Google Scholar]
  6. Wang H, Ling C, Chen C, He HY, Luo L, Ning XJ, , 2014. Evaluation of ventriculoperitoneal shunt in the treatment of intracranial hypertension in the patients with cryptococcal meningitis: a report of 12 cases. Clin Neurol Neurosurg 124: 156160.[Crossref] [Google Scholar]
  7. Dincer A, Ozek MM, , 2011. Radiologic evaluation of pediatric hydrocephalus. Childs Nerv Syst 27: 15431562.[Crossref] [Google Scholar]
  8. Pople IK, , 2002. Hydrocephalus and shunts: what the neurologist should know. J Neurol Neurosurg Psychiatry 73 (Suppl 1): i17i22.[Crossref] [Google Scholar]
  9. Cherian J, Atmar RL, Gopinath SP, , 2016. Shunting in cryptococcal meningitis. J Neurosurg 125: 177186.[Crossref] [Google Scholar]
  10. Denning DW, Armstrong RW, Lewis BH, Stevens DA, , 1991. Elevated cerebrospinal fluid pressures in patients with cryptococcal meningitis and acquired immunodeficiency syndrome. Am J Med 91: 267272.[Crossref] [Google Scholar]
  11. Bicanic T, , 2009. Relationship of cerebrospinal fluid pressure, fungal burden and outcome in patients with cryptococcal meningitis undergoing serial lumbar punctures. AIDS 23: 701706. [Google Scholar]
  12. Perfect JR, , 2010. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of America. Clin Infect Dis 50: 291322.[Crossref] [Google Scholar]
  13. Woodworth GF, McGirt MJ, Williams MA, Rigamonti D, , 2005. The use of ventriculoperitoneal shunts for uncontrollable intracranial hypertension without ventriculomegally secondary to HIV-associated cryptococcal meningitis. Surg Neurol 63: 529531.[Crossref] [Google Scholar]
  14. Liliang PC, , 2003. Shunt surgery for hydrocephalus complicating cryptococcal meningitis in human immunodeficiency virus negative patients. Clin Infect Dis 37: 673678.[Crossref] [Google Scholar]
  15. Richardson PM, Mohandas A, Arumugasamy N, , 1976. Cerebral cryptococcosis in Malaysia. J Neurol Neurosurg Psychiatry 39: 330337.[Crossref] [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.4269/ajtmh.17-0177
Loading
/content/journals/10.4269/ajtmh.17-0177
Loading

Data & Media loading...

  • Received : 08 Mar 2017
  • Accepted : 28 Jun 2017

Most Cited This Month

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error