952. Study of prevalence, risk factors and outcomes of abdominal pseudocyst(APC) in patients with coccidioidal meningitis(CM) and ventriculoperitoneal shunts(VPS)
Session: Poster Abstract Session: Clinical Mycology
Saturday, October 22, 2011
Room: Poster Hall B1
Handouts
  • Narasimhanposter2011A.pdf (114.2 kB)
  • Background: 

    Coccidioidal meningitis (CM) is the most feared complication of coccidioidomycosis and ventriculoperitoneal shunts (VPS) are frequently employed to relieve the hydrocephalus in these patients. Abdominal pseudocyst (APC) is a rare complication of ventriculoperitoneal shunts (VPS) with a reported incidence of 1%-5%. The objective of our study was to evaluate the prevalence, predisposing factors and outcomes of APC among patients with CM and VPS.

    Methods: 

    We retrospectively reviewed the demographics, risk factors and outcomes 33 patients( 6 with APC) with CM and VPS at our institution during a 10- year period from 2000-2010. Descriptive analysis was then performed.

    Results: 

    Six of 33 patients had APC (group 1) and 27 of 33 patients (group 2) did not develop APC. The baseline characteristics and pertinent results are summarized in table 1.

     

    Group 1

    n=6

    Group 2

    n=27

    Mean Age

    34 +/- 7

    49+/-16

    Race

    Hispanic-5

    Caucasian-1

    Hispanic-19

    Africanamerican-3

    Asian-2

    Unspecified-3

    Sex

    Male-4

    Female-2

    Male-23

    Female-4

    Comorbidities

    Diabetes Mellitus 2(DM2)- 1

     

    DM2-5

    Human immunodeficiency virus-1

    Positive fungal cultures on the cerebrospinal fluid(Csf)

    3(50%)

    8(29%)

    Csf  coccidioidomycosis serology >1:16

    4(66%)

    7(26%)

    Average Csf protein

    287+/-311

    332+/578

    Average Csf WBC

    111+/-145

    142+/-189

    Mean number of shunt revisions

    2

    1.8

    Shunt infection

    0

    4

    Non compliance with antifungal

    P=0.06

    3(50%)

    3(11%)

    Mortality

    1

    7

    Conclusion: 

    The prevalence of APC at our institution was 18%. Non compliance with antifungal was an independent risk factor for development of APC. Positive fungal cultures in Csf and high Csf coccidioidomycosis serology may predispose to the development of APC. The groups are very small to assess for differences in mortality. Larger prospective studies are necessary to confirm the observations noted in our study.


    Subject Category: M. Mycology including clinical and basic studies of fungal infections

    Aarthi Narasimhan, MD1, Ali Rashidian, MD2, Graciela Faiad, MD1, Robert D. Libke, MD1, Simon Paul, MD1, Naiel Nassar, MD3 and Shobha Sharma, DO1, (1)Infectious Diseases, UCSF-Fresno, Fresno, CA, (2)Internal Medicine, UCSF, Fresno, Fresno, CA, (3)Infectious Diseases, UCSF- Fresno, Fresno, CA

    Disclosures:

    A. Narasimhan, None

    A. Rashidian, None

    G. Faiad, None

    R. D. Libke, None

    S. Paul, None

    N. Nassar, None

    S. Sharma, None

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