{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T20:47:42Z","timestamp":1778014062632,"version":"3.51.4"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2025,8,12]],"date-time":"2025-08-12T00:00:00Z","timestamp":1754956800000},"content-version":"vor","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,31]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Ventriculoperitoneal (VP) shunts are the mainstay for cerebrospinal fluid diversion in patients with refractory coccidioidal meningitis (CM)-associated hydrocephalus. Abdominal pseudocysts (APCs), an uncommon but known complication of distal shunt catheters, have not been well described in CM. We conducted a retrospective study of 124 patients with CM who underwent VP shunt placement between 2010 and 2024. APCs occurred in 21 patients (17%), with most presenting with symptoms of shunt malfunction rather than abdominal complaints. This incidence is notably higher than previously reported in patients with hydrocephalus due to other etiologies. Evidence of active Coccidioides infection was present in 71% of patients. Imaging typically revealed fluid collections at the distal catheter tip, and most patients underwent surgical intervention targeting the distal shunt. Despite intervention, recurrent shunt failures occurred in a substantial proportion. These findings add to the limited literature on APCs in CM and may inform future research into their presentation, contributing factors, and management.<\/jats:p>","DOI":"10.1093\/ofid\/ofaf486","type":"journal-article","created":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T01:19:18Z","timestamp":1755047958000},"source":"Crossref","is-referenced-by-count":1,"title":["Trapped Below: Abdominal Pseudocysts Associated With Ventriculoperitoneal Shunts in Coccidioidal Meningitis"],"prefix":"10.1093","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8443-7095","authenticated-orcid":false,"given":"Geetha","family":"Sivasubramanian","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases, University of California, San Francisco , Fresno, California ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,8,12]]},"reference":[{"key":"2025082607320287100_ofaf486-B1","doi-asserted-by":"crossref","first-page":"54","DOI":"10.3390\/jof5030054","article-title":"Central nervous system infections due to coccidioidomycosis","volume":"5","author":"Jackson","year":"2019","journal-title":"J Fungi (Basel)"},{"key":"2025082607320287100_ofaf486-B2","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1086\/497596","article-title":"Coccidioidal meningitis","volume":"42","author":"Johnson","year":"2006","journal-title":"Clin Infect Dis"},{"key":"2025082607320287100_ofaf486-B3","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.spen.2009.01.002","article-title":"A contemporary definition and classification of hydrocephalus","volume":"16","author":"Rekate","year":"2009","journal-title":"Semin Pediatr Neurol"},{"key":"2025082607320287100_ofaf486-B4","first-page":"773","article-title":"Hydrocephalus in coccidioidal meningitis: case report and review of the literature","volume":"47","author":"Romeo","year":"2000","journal-title":"Neurosurgery"},{"key":"2025082607320287100_ofaf486-B5","doi-asserted-by":"crossref","first-page":"e883","DOI":"10.1016\/j.wneu.2020.03.135","article-title":"Shunt treatment for coccidioidomycosis-related hydrocephalus: a single-center series","volume":"138","author":"Morshed","year":"2020","journal-title":"World Neurosurg"},{"key":"2025082607320287100_ofaf486-B6","doi-asserted-by":"crossref","first-page":"785","DOI":"10.3171\/2014.6.JNS14111","article-title":"Patient outcomes and surgical complications in coccidioidomycosis-related hydrocephalus: an institutional review","volume":"121","author":"Hardesty","year":"2014","journal-title":"J Neurosurg"},{"key":"2025082607320287100_ofaf486-B7","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1016\/j.pediatrneurol.2005.05.021","article-title":"Failure of cerebrospinal fluid shunts: part II: overdrainage, loculation, and abdominal complications","volume":"34","author":"Browd","year":"2006","journal-title":"Pediatr Neurol"},{"key":"2025082607320287100_ofaf486-B8","first-page":"350","article-title":"Ascites and abdominal pseudocysts following ventriculoperitoneal shunt surgery: variations of the same theme","volume":"106","author":"Kariyattil","year":"2007","journal-title":"J Neurosurg"},{"key":"2025082607320287100_ofaf486-B9","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1007\/BF01808551","article-title":"Abdominal CSF pseudocysts in patients with ventriculo-peritoneal shunts. Report of fourteen cases and review of the literature","volume":"127","author":"Rainov","year":"1994","journal-title":"Acta Neurochir (Wien)"},{"key":"2025082607320287100_ofaf486-B10","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1159\/000085160","article-title":"Abdominal pseudocyst: predisposing factors and treatment algorithm","volume":"41","author":"Mobley","year":"2005","journal-title":"Pediatr Neurosurg"},{"key":"2025082607320287100_ofaf486-B11","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1159\/000120223","article-title":"Abdominal CSF pseudocyst. Clinical features and surgical management","volume":"12","author":"Hahn","year":"1985","journal-title":"Pediatr Neurosci"},{"key":"2025082607320287100_ofaf486-B12","doi-asserted-by":"crossref","first-page":"926","DOI":"10.1128\/JCM.02731-14","article-title":"Development of a real-time PCR assay for identification of Coccidioides immitis by use of the BD Max system","volume":"53","author":"Mitchell","year":"2015","journal-title":"J Clin Microbiol"},{"key":"2025082607320287100_ofaf486-B13","doi-asserted-by":"crossref","first-page":"1780","DOI":"10.1212\/WNL.0b013e3181c34b69","article-title":"Coccidioidal meningitis and brain abscesses: analysis of 71 cases at a referral center","volume":"73","author":"Drake","year":"2009","journal-title":"Neurology"},{"key":"2025082607320287100_ofaf486-B14","volume-title":"StatPearls","author":"Fowler","year":"2023"},{"key":"2025082607320287100_ofaf486-B15","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1159\/000028875","article-title":"Abdominal pseudocysts complicating CSF shunting in infants and children. Report of 18 cases","volume":"31","author":"Salom\u00e3o","year":"1999","journal-title":"Pediatr Neurosurg"},{"key":"2025082607320287100_ofaf486-B16","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1016\/S1072-7515(02)01751-9","article-title":"Intraabdominal pseudocysts as a complication of ventriculoperitoneal shunts","volume":"196","author":"Anderson","year":"2003","journal-title":"J Am Coll Surg"},{"key":"2025082607320287100_ofaf486-B17","first-page":"CD012726","article-title":"Ventriculo-peritoneal shunting devices for hydrocephalus","volume":"6","author":"Garegnani","year":"2020","journal-title":"Cochrane Database Syst Rev"},{"key":"2025082607320287100_ofaf486-B18","doi-asserted-by":"crossref","first-page":"2719","DOI":"10.1007\/s00381-023-06070-4","article-title":"Cerebrospinal fluid shunt malfunctions: a reflective review","volume":"39","author":"Low","year":"2023","journal-title":"Childs Nerv Syst"},{"key":"2025082607320287100_ofaf486-B19","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1111\/j.1440-1673.2007.01909.x","article-title":"Abdominal cerebrospinal fluid pseudocyst: a complication of ventriculoperitoneal shunts in adults","volume":"52","author":"Aparici-Robles","year":"2008","journal-title":"J Med Imaging Radiat Oncol"},{"key":"2025082607320287100_ofaf486-B20","first-page":"e69958","article-title":"Incidence and management of pseudocysts in patients with ventriculoperitoneal shunts: a study in Pakistan","volume":"16","author":"Ihsan","year":"2024","journal-title":"Cureus"},{"key":"2025082607320287100_ofaf486-B21","doi-asserted-by":"crossref","first-page":"e582","DOI":"10.1016\/j.wneu.2022.05.008","article-title":"Comparison of shunt outcomes for nonbacterial infection hydrocephalus with common hydrocephalus etiologies: a retrospective case-control study","volume":"164","author":"Cummins","year":"2022","journal-title":"World Neurosurg"},{"key":"2025082607320287100_ofaf486-B22","first-page":"188","article-title":"Peritoneal cysts: a complication of ventriculoperitoneal shunts","volume":"79","author":"Gutierrez","year":"1976","journal-title":"Surgery"},{"key":"2025082607320287100_ofaf486-B23","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1007\/BF00271925","article-title":"Peritoneal cerebrospinal fluid pseudocysts: a complication of ventriculoperitoneal shunts","volume":"4","author":"Burchianti","year":"1988","journal-title":"Childs Nerv Syst"}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ofid\/advance-article-pdf\/doi\/10.1093\/ofid\/ofaf486\/64030153\/ofaf486.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/12\/8\/ofaf486\/64030153\/ofaf486.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/12\/8\/ofaf486\/64030153\/ofaf486.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,26]],"date-time":"2025-08-26T11:32:10Z","timestamp":1756207930000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofaf486\/8232782"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,31]]},"references-count":23,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2025,7,31]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofaf486","relation":{},"ISSN":["2328-8957"],"issn-type":[{"value":"2328-8957","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,8]]},"published":{"date-parts":[[2025,7,31]]},"article-number":"ofaf486"}}