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Shunt-related intracranial abscess caused by Staphylococcus lugdunensis in a hydranencephalic patient
Yan Michael Li1, Donald J Blaskiewicz, Walter A Hall
1Department of Neurosurgery, State University of New York Upstate Medical University, Syracuse, New York, USA.
Background:
Staphylococcus lugdunensis is a coagulase-negative staphylococcus with aggressive and rapidly progressive infectious behavior. This organism has emerged as an important pathogen implicated in both community-acquired and nosocomial infections, including meningitis, brain abscess, catheter-related bacteremia, and ventriculoperitoneal shunt infection.
Case Description:
We report the first known case of Staphylococcus lugdunensis intracranial abscess in a pediatric hydranencephalic patient, caused by a ventriculoperitoneal shunt-related infection. Further magnetic resonance imaging (MRI) confirmed a large abscess within the cranium that demonstrated multiple loculations. The patient received externalization of the right occipital ventricular catheter with evacuation of the brain abscess. Medical management included one week of intrathecal antibiotic treatment, and she was discharged on long-term intravenous rifampin and vancomycin, leading to cure of the infection.
Conclusion:
This case suggests that if Staphylococcus lugdunensis is identified, a virulent and prolonged clinical course with the production of destructive lesions, similar to those with S. aureus, should be expected. A course of antibiotic therapy and aggressive management that may include surgical treatment will be needed.
Insights
Staphylococcus lugdunensis can cause aggressive brain abscesses, particularly in shunt infections. Prompt medical and surgical intervention is crucial for successful treatment and cure.
Area of Science:
- Infectious Diseases
- Pediatric Neurology
- Neurosurgery
Background:
- Staphylococcus lugdunensis is an emerging pathogen causing severe infections.
- It is associated with aggressive and rapidly progressive infectious behavior.
- Known infections include meningitis, brain abscesses, and shunt-related infections.
Observation:
- First reported case of Staphylococcus lugdunensis intracranial abscess in a pediatric patient with hydranencephaly.
- The infection was linked to a ventriculoperitoneal shunt.
- Magnetic resonance imaging revealed a large, multiloculated intracranial abscess.
Findings:
- The patient underwent externalization of the ventricular catheter and abscess evacuation.
- Intrathecal antibiotic treatment was administered for one week.
- Long-term intravenous therapy with rifampin and vancomycin led to infection resolution.
Implications:
- Staphylococcus lugdunensis infections may present with virulent, destructive lesions similar to Staphylococcus aureus.
- Aggressive management, including surgical intervention and prolonged antibiotic therapy, is necessary.
- Early identification and treatment are vital for favorable outcomes in pediatric neurosurgical infections.
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