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Cerebrospinal fluid shunt infections with anaerobic diphtheroids (Propionibacterium species)
Abstract:
The clinical and laboratory findings in six cases of anaerobic diphtheroid infection of cerebrospinal fluid shunts are described. These organisms have been infrequently reported as a cause of shunt infections but our data indicate that such infections may be more common than currently appreciated. Propionibacterium species are common contaminants of cerebrospinal fluid specimens, but when isolated from the spinal fluid of a patient with a shunt who has symptoms and signs compatible with infection, the organism should not be dismissed as a contaminant. Fever was a constant finding frequently accompanied by signs of central nervous system dysfunction. Spinal fluid pleocytosis was usually limited to 1 to 200 cells and protein and sugar values were variable. The organisms grow slowly, therefore spinal fluid cultures should be held for at least 14 days before they are reported as negative.
Insights
Anaerobic diphtheroid infections of cerebrospinal fluid shunts are uncommon but may be underestimated. Prompt identification and prolonged culture are crucial for diagnosing these difficult-to-detect infections.
Area of Science:
- Infectious Diseases
- Neurosurgery
- Clinical Microbiology
Background:
- Cerebrospinal fluid (CSF) shunts are devices used to treat hydrocephalus.
- Infections of CSF shunts can lead to serious complications.
- Anaerobic diphtheroids, such as Propionibacterium species, are infrequently reported as causes of shunt infections.
Purpose of the Study:
- To describe the clinical and laboratory findings in six cases of anaerobic diphtheroid infection of CSF shunts.
- To highlight the potential underestimation of these infections.
- To emphasize the importance of considering these organisms in shunt infections.
Main Methods:
- Retrospective review of six patients with CSF shunt infections caused by anaerobic diphtheroids.
- Analysis of clinical presentations, laboratory findings, and microbiological data.
- Evaluation of diagnostic challenges and treatment outcomes.
Main Results:
- Fever and signs of central nervous system dysfunction were common clinical findings.
- CSF analysis often showed mild pleocytosis (1-200 cells) with variable protein and sugar levels.
- Propionibacterium species, common contaminants, were identified as causative agents in these shunt infections.
- Organisms grew slowly, necessitating prolonged culture incubation (at least 14 days).
Conclusions:
- Anaerobic diphtheroid shunt infections may be more common than previously recognized.
- Propionibacterium species isolated from CSF shunts in infected patients should not be dismissed as contaminants.
- Extended incubation of CSF cultures is essential for the diagnosis of these infections.
- Early recognition and appropriate management are critical for favorable patient outcomes.