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Clinical characteristic of 15 cases of cryptococcal meningitis treated with Ommaya reservoir

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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.

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References

  1. Durski KN, Kuntz KM, Yasukawa K, Virnig BA, Meya DB, Boulware DR (2013) Cost-effective diagnostic checklists for meningitis in resource-limited settings. J Acquir Immune Defic Syndr 63(3):e101–108. https://doi.org/10.1097/QAI.0b013e31828e1e56

    Article  PubMed  PubMed Central  Google Scholar 

  2. Williamson PR, Jarvis JN, Panackal AA, Fisher MC, Molloy SF, Loyse A, Harrison TS (2017) Cryptococcal meningitis: epidemiology, immunology, diagnosis and therapy. Nat Rev Neurol 13(1):13–24. https://doi.org/10.1038/nrneurol.2016.167

    Article  CAS  PubMed  Google Scholar 

  3. Pyrgos V, Seitz AE, Steiner CA, Prevots DR, Williamson PR (2013) Epidemiology of cryptococcal meningitis in the US: 1997–2009. PLoS One 8(2):e56269. https://doi.org/10.1371/journal.pone.0056269

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. van der Horst CM, Saag MS, Cloud GA, Hamill RJ, Graybill JR, Sobel JD, Johnson PC, Tuazon CU, Kerkering T, Moskovitz BL, Powderly WG, Dismukes WE (1997) Treatment of cryptococcal meningitis associated with the acquired immunodeficiency syndrome. National Institute of Allergy and Infectious Diseases Mycoses Study Group and AIDS Clinical Trials Group. N Engl J Med 337(1):15–21. https://doi.org/10.1056/nejm199707033370103

    Article  PubMed  Google Scholar 

  5. Chang CC, Perfect JR (2016) Repeated therapeutic lumbar punctures in cryptococcal meningitis—necessity and/or opportunity? Curr Opin Infect Dis 29(6):539–545. https://doi.org/10.1097/QCO.0000000000000315

    Article  CAS  PubMed  Google Scholar 

  6. Ommaya AK (1963) Subcutaneous reservoir and pump for sterile access to ventricular cerebrospinal fluid. Lancet 2(7315):983–984

    Article  CAS  PubMed  Google Scholar 

  7. Ratcheson RA, Ommaya AK (1968) Experience with the subcutaneous cerebrospinal-fluid reservoir. Preliminary report of 60 cases. N Engl J Med 279(19):1025–1031. https://doi.org/10.1056/nejm196811072791904

    Article  CAS  PubMed  Google Scholar 

  8. Jiang PF, Yu HM, Zhou BL, Gao F, Shen SX, Xia ZZ, Shui QX (2010) The role of an Ommaya reservoir in the management of children with cryptococcal meningitis. Clin Neurol Neurosurg 112(2):157–159. https://doi.org/10.1016/j.clineuro.2009.10.006

    Article  PubMed  Google Scholar 

  9. Nakama T, Yamashita S, Hirahara T, Okamoto S, Honda S, Watanabe M, Kimura E, Uchino M, Yano S, Kuratsu J, Ando Y (2015) Usefulness of intraventricular infusion of antifungal drugs through Ommaya reservoirs for cryptococcal meningitis treatment. J Neurol Sci 358(1–2):259–262. https://doi.org/10.1016/j.jns.2015.09.005

    Article  CAS  PubMed  Google Scholar 

  10. Wei BZ, Qian C, Liu Y, Lin X, Wan J, Wang YG (2017) Ommaya reservoir in the treatment of cryptococcal meningitis. Acta Neurol Belg 117(1):283–287. https://doi.org/10.1007/s13760-016-0682-6

    Article  PubMed  Google Scholar 

  11. Huang CF, Yang DY, Wang YC, Lau YJ (1993) Effect of implantation of an Ommaya reservoir on prognosis for cryptococcal meningitis. Zhonghua Yi Xue Za Zhi (Taipei) 52(1):36–40

    CAS  Google Scholar 

  12. Jiang PF, Zhu T (2005) A case of cryptococcal meningitis successfully treated with placing Ommaya reservoir into ventricle. Zhonghua Er Ke Za Zhi 43(6):470–471

    PubMed  Google Scholar 

  13. Rajasingham R, Smith RM, Park BJ, Jarvis JN, Govender NP, Chiller TM, Denning DW, Loyse A, Boulware DR (2017) Global burden of disease of HIV-associated cryptococcal meningitis: an updated analysis. Lancet Infect Dis 17(8):873–881. https://doi.org/10.1016/S1473-3099(17)30243-8

    Article  PubMed  PubMed Central  Google Scholar 

  14. Perfect JR, Dismukes WE, Dromer F, Goldman DL, Graybill JR, Hamill RJ, Harrison TS, Larsen RA, Lortholary O, Nguyen MH, Pappas PG, Powderly WG, Singh N, Sobel JD, Sorrell TC (2010) Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america. Clin Infect Dis 50(3):291–322. https://doi.org/10.1086/649858

    Article  PubMed  Google Scholar 

  15. Migone C, Ford N, Garner P, Eshun-Wilson I (2018) Updating guidance for preventing and treating cryptococcal disease: how evidence and decisions interface. Cochrane Db Syst Rev 1:1. https://doi.org/10.1002/14651858.ed000130

    Article  Google Scholar 

  16. Coenjaerts FE, van der Flier M, Mwinzi PN, Brouwer AE, Scharringa J, Chaka WS, Aarts M, Rajanuwong A, van de Vijver DA, Harrison TS, Hoepelman AI (2004) Intrathecal production and secretion of vascular endothelial growth factor during Cryptococcal Meningitis. J Infect Dis 190(7):1310–1317. https://doi.org/10.1086/423849

    Article  CAS  PubMed  Google Scholar 

  17. Hung CW, Lin WC, Chang WN, Su TM, Kung CT, Tsai NW, Wang HC, Huang CC, Cheng BC, Su YJ, Chang YT, Su CM, Hsiao SY, Lu CH (2018) Risk factors and outcomes of cerebrospinal fluid overdrainage in HIV-negative patients with cryptococcal meningitis after the ventriculoperitoneal shunting procedure. J Microbiol Immunol Infect 51(4):545–551. https://doi.org/10.1016/j.jmii.2017.06.002

    Article  PubMed  Google Scholar 

  18. Obbens EA, Leavens ME, Beal JW, Lee YY (1985) Ommaya reservoirs in 387 cancer patients: a 15-year experience. Neurology 35(9):1274–1278

    Article  CAS  PubMed  Google Scholar 

  19. Dickerman RD, Eisenberg MB (2005) Preassembled method for insertion of Ommaya reservoir. J Surg Oncol 89(1):36–38. https://doi.org/10.1002/jso.20174

    Article  PubMed  Google Scholar 

  20. Mechleb B, Khater F, Eid A, David G, Moorman JP (2003) Late onset Ommaya reservoir infection due to Staphylococcus aureus: case report and review of Ommaya infections. J Infection 46(3):196–198. https://doi.org/10.1053/jinf.2002.1111

    Article  CAS  Google Scholar 

  21. Siegal T, Pfeffer MR, Steiner I (1988) Antibiotic therapy for infected Ommaya reservoir systems. Neurosurgery 22(1 Pt 1):97–100

    Article  CAS  PubMed  Google Scholar 

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Author notes

  1. Yingfeng Wan and Xinwei Li contributed equally in this article.

Authors and Affiliations

  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

    Yingfeng Wan, Xinwei Li, Yirong Wang, Yunsong Yu & Shuxu Yang

  2. Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China

    Yunsong Yu

  3. Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, People’s Republic of China

    Yunsong Yu

Authors
  1. Yingfeng Wan
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  2. Xinwei Li
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  3. Yirong Wang
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  4. Yunsong Yu
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Correspondence to Shuxu Yang.

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The study was approved and supervised by the Medical Ethics Committee of the Sir Run Run Shaw Hospital, Zhejiang University school of medicine, China.

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Wan, Y., Li, X., Wang, Y. et al. Clinical characteristic of 15 cases of cryptococcal meningitis treated with Ommaya reservoir. Acta Neurol Belg 120, 1139–1145 (2020). https://doi.org/10.1007/s13760-019-01193-5

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  • DOI: https://doi.org/10.1007/s13760-019-01193-5

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