title: Fungal infection of a ventriculoperitoneal shunt: histoplasmosis diagnosis and treatment.
abstract: BACKGROUND
  Histoplasmosis is a fungal disease caused by Histoplasma capsulatum, commonly found in the Americas, and Histoplasma duboisii, located in Africa. In the United States, H. capsulatum is prevalent in the Ohio and Mississippi river valleys. In rare circumstances, central nervous system (CNS) histoplasmosis infection can be caused by shunt placement. We present a case report of a 45-year-old woman in whom CNS histoplasmosis developed after having a ventriculoperitoneal (VP) shunt placed for communicating hydrocephalus. A review of the literature on fungal infections after CNS shunt placement as well as treatment options for this subset of patients was undertaken.
  
  
  METHODS
  The PubMed database current to 1958 was filtered and limited to English-language articles. Fifty-eight articles were selected for review based on evidence of information regarding the fungal organism responsible for shunt infection, symptoms, treatment, and/or outcomes. Also included in this review is our case study.
  
  
  RESULTS
  A thorough analysis of the PubMed database revealed 58 reported cases of CNS shunt-related fungal infections in the English-language medical literature as well as 7 therapeutic agents used to treat patients in whom postshunt fungal infections developed.
  
  
  CONCLUSIONS
  We describe the steps in diagnosis of histoplasmosis after shunt placement, provide an effective therapeutic regimen, and review the present understanding of CNS fungal infections. The medical literature was surveyed to compare and analyze various CNS fungal infections that can arise from shunt placement as well as treatments rendered.
authors.affiliation: Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA.
authors.forename: Anand
authors.initials: A
authors.lastname: Veeravagu
authors.forename: Cassie
authors.initials: C
authors.lastname: Ludwig
authors.forename: Joaquin Q
authors.initials: JQ
authors.lastname: Camara-Quintana
authors.forename: Bowen
authors.initials: B
authors.lastname: Jiang
authors.forename: Nandan
authors.initials: N
authors.lastname: Lad
authors.forename: Lawrence
authors.initials: L
authors.lastname: Shuer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000935:Antifungal Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D005260:Female; D006660:Histoplasmosis / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D006801:Humans; D006849:Hydrocephalus / Q000601:surgery; D007223:Infant; D017964:Itraconazole / Q000627:therapeutic use; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D012086:Reoperation; D013129:Spinal Puncture; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D017964:Itraconazole