Central Nervous System Infections Caused by Mycobacterium abscessus: Ventricular Shunt Infection in Two Pediatric...

Area of Science:

• Infectious Diseases
• Pediatric Neurology
• Neurosurgery

Background:

• Central nervous system (CNS) infections in premature infants pose significant challenges.
• Hydrocephalus secondary to intraventricular hemorrhage (IVH) often necessitates cerebrospinal fluid (CSF) shunting.
• Mycobacterium abscessus is an emerging opportunistic pathogen with increasing clinical relevance.

Observation:

• Two pediatric patients, a 4-year-old male and an 18-month-old female, both with histories of prematurity (24 and 26 weeks gestation, respectively) and IVH-induced hydrocephalus requiring shunts, presented with M. abscessus infections.
• Infections involved both the shunt track and ventricular fluid, indicating disseminated disease.
• The 4-year-old patient required over two months of triple intravenous antibiotics and intraventricular amikacin for CSF sterilization.

Findings:

• Complete resolution of M. abscessus CNS infections was achieved only after complete removal of all foreign materials (shunts).
• Extensive surgical debridement of infected shunt track tissue was crucial for infection control.
• Prolonged combination antimycobacterial therapy was essential but associated with significant challenges.

Implications:

• Central nervous system infections caused by Mycobacterium abscessus are rare but associated with high morbidity and mortality.
• Management necessitates a multidisciplinary approach involving infectious disease specialists, neurosurgeons, and neurologists.
• Aggressive surgical intervention combined with prolonged, tailored antimicrobial therapy is critical for favorable outcomes in these challenging cases.