CRYPTOCOCCAL VENTRICULAR-PERITONEAL SHUNT INFECTION - CLINICAL AND EPIDEMIOLOGIC EVALUATION OF 2 CLOSELY ASSOCIATED CASES

OBJECTIVE: To determine the cause of meningitis associated with Crypto coccus neoformans in two patients with recent ventricular-peritoneal ( VP) shunt placement. DESIGN. A retrospective review of materials, reco rds, and concurrent cases of VP shunt procedures. Isolates of C neofor mans from each patient were submitted for analysis by colony morpholog y, biochemical testing, and karyotyping by pulsed-field electrophoresi s. SETTING: Two 400-bed community hospitals. PATIENTS: Two immunocompe tent patients presented with symptoms of progressive hydrocephalus in August 1991. Each received a VP shunt on the same day by the same surg eon using materials from a common vendor and hospital. RESULTS: Both p atients presented within six to eight weeks with symptoms of fever, he adache, rash, and cultures of cerebrospinal fluid (CSF) that yielded C neoformans. Each patient recovered after therapy with amphotericin B and flucytosine followed by several months of fluconazole, although on e required replacement of the VP shunt for cure. Review of each patien t's history and CSF characteristics at the time of shunt placement sug gested reactivation of a preexisting infection. Isolates of C neoforma ns from each patient were submitted for analysis by colony morphology, biochemical testing, and karyotyping by pulsed-field electrophoresis. Each isolate was found to be unique by chromosomal karyotyping. CONCL USIONS: Our data and previous reports suggest that cryptococcal VP shu nt infections appear to be a complication of shunts placed in previous ly infected persons rather than nosocomial transmission of cryptococcu s during placement.