Clinical characteristic of 15 cases of cryptococcal meningitis treated with Ommaya reservoir
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ORIGINAL ARTICLE
Clinical characteristic of 15 cases of cryptococcal meningitis treated with Ommaya reservoir Yingfeng Wan1 · Xinwei Li1 · Yirong Wang1 · Yunsong Yu1,2,3 · Shuxu Yang1 Received: 18 April 2019 / Accepted: 8 July 2019 © Belgian Neurological Society 2019
Abstract Cryptococcal meningitis is a severe subacute fungal meningoencephalitis. Intracerebroventricular (ICV) injection of antifungal medication and aspiration of cerebrospinal fluid (CSF) through Ommaya reservoir were reported to be useful cryptococcal meningitis treatment method. We want to evaluate the role of Ommaya reservoir in the treatment of refractory cryptococcal meningitis. We retrospectively analyzed clinical records and data of 15 refractory cryptococcal meningitis patients who were treated with Ommaya reservoir in Sir Run Run Shaw hospital from June 2013 to June 2017. Fifteen patients who underwent Ommaya reservoir implanted surgery include eight women and seven men. Headache and fever were the common clinical symptoms. Underlying diseases mainly include diabetes mellitus and hypertension. Three patients occurred renal dysfunction and four patients experienced liver damage. Thirteen patients recovered completely, whereas two patients died. Implant Ommaya reservoir which can serial extract CSF and ICV injection of Amphotericin B is a valuable approach in the treatment of Cryptococcal meningitis, especially for patients with refractory intracranial hypertension. Keywords Ommaya reservoir · Amphotericin B · Cryptococcal meningitis · Treatment
Introduction Cryptococcal meningitis (CM) is a severe subacute fungal meningoencephalitis. It is the most common type of adult meningitis in large areas throughout the world with high incidence of human immunodeficiency virus (HIV) infection [1]. According to the published data, the morbidity of HIV-associated CM was estimated about 1,000,000/year, together with at least 100,000 patients dead every year in Sub-Saharan African [2]. In America, patients died from
Yingfeng Wan and Xinwei Li contributed equally in this article. * Shuxu Yang [email protected] 1
Department of Neurosurgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No 3, Qingchun East Road, Hangzhou, People’s Republic of China
2
Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
3
Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, People’s Republic of China
non-HIV-related CM account for almost 25% of CM-related hospitalizations [3]. Cryptococcal meningitis treatment mainly contains two parts: antifungal therapy and high intracranial pressure management. Guidelines for first-line antifungal treatment are based on a three-step “induction, consolidation, and maintenance” protocol which was used in the Mycoses Study Group trial in 1997 [4]. Higher intracranial pressure is positive correlation with worse symptoms, including headache, diplopia, nerve palsies, and unconsciousn
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