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Deborah Mangham, MD; Dale N. Gerding, MD; Lance R. Peterson, MD; George A. Sarosi, MD

Arch Intern Med. 1983;143(4):728-731.

Abstract
• Four patients with fungal meningitis and hydrocephalus were treated by placement of intraventricular shunts prior to the diagnosis of infection. As a consequence, they were subjected to the risks of surgery as well as to shunt suprainfection. We suggest that chronic meningitis be ruled out in all patients prior to placement of shunts. Preoperative evaluation should include the examination of cisternal or ventricular CSF when a lumbar CSF specimen is nondiagnositc. When fungal meningitis is present, a course of amphotericin B should be initiated and the CSF sterilized prior to the placement of the permanent extracranial shunt. Where acute hydrocephalus supervenes, temporary ventricular drainage may be employed. In some cases of fungal meningitis, the symptoms of hydrocephalus will be resolved with antifungal therapy alone, obviating the need for ventricular decompression.

(Arch Intern Med 1983;143:728-731)

Author Affiliations
From the Department of Medicine, Minneapolis Veterans Administration Medical Center.

Footnotes
Accepted for publication Oct 4, 1982.

Reprint requests to Medical Education Office, Abbott-Northwestern Hospital, 800 E 28th St at Chicago Avenue, Minneapolis, MN 55407 (Dr Sarosi).

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