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Updated: Feb 7, 2026
Neuronavigation and Laparoscopy Guided Ventriculoperitoneal Shunt Insertion for the Treatment of Hydrocephalus
Published on: October 14, 2022
Unexpected eosinophilia in children affected by hydrocephalus accompanied with shunt infection
Bartosz Polis1, Lech Polis1, Krzysztof Zeman2
1Department of Neurosurgery, Polish Mother's Memorial Hospital Research Institute, Rzgowska st 281/289, 93-338, Łódź, Poland.
Purpose:
The aim of the article is to describe an immunological reaction to shunt infection in children with hydrocephalus. The main cause of shunt infection involves methicillin resistant Staphylococcus epidermidis (Bhatia et al. Indian J Med Microbiol 35:120-123, 2017; Hayhurst et al. Childs Nerv Syst 24:557-562, 2008; Martínez-Lage et al. Childs Nerv Syst 26: 1795-1798, 2010; Simon et al. PLoS One, 2014; Snowden et al. PLoS One 8:e84089, 2013; Turgut et al. Pediatr Neurosurg 41:131-136, 2005), a bacterial strain which is responsible for the formation of biofilm on contaminated catheters (Snowden et al. PLoS One 8:e84089, 2013; Stevens et al. Br J of Neurosurg 26: 792-797, 2012).
Methods:
The study group involved 30 children with congenital hydrocephalus after shunt system implantation, whose procedures were complicated by S. epidermidis implant infection. Thirty children with congenital hydrocephalus awaiting their first-time shunt implantation formed the control group. The level of eosinophils in peripheral blood was assessed in both groups. Cerebrospinal fluid (CSF) was examined for protein level, pleocytosis, interleukins, CCL26/Eotaxin-3, IL-5, IL-6, CCL11/Eotaxin-1, CCL3/MIP-1a, and MBP. Three measurements were performed in the study group. The first measurement was obtained at the time of shunt infection diagnosis, the second one at the time of the first sterile shunt, and the third one at the time of shunt reimplantation. In the control group, blood and CSF samples were taken once, at the time of shunt implantation.
Results:
In the clinical material, the highest values of eosinophils in peripheral blood and CSF pleocytosis were observed in the second measurement. It was accompanied by an increase in the majority of analyzed CSF interleukins.
Conclusion:
CSF pleocytosis observed in the study group shortly after CSF sterilization is presumably related to an allergic reaction to Staphylococcus epidermidis, the causative agent of ventriculoperitoneal shunt infection.
Insights
Pediatric hydrocephalus shunt infections caused by Staphylococcus epidermidis may trigger allergic reactions, indicated by elevated eosinophils and cerebrospinal fluid (CSF) pleocytosis after treatment.
Area of Science:
- Pediatric Neurosurgery
- Infectious Diseases
- Immunology
Background:
- Hydrocephalus is a common condition in children requiring shunt placement.
- Shunt infections, often caused by Staphylococcus epidermidis, are a significant complication.
- Methicillin-resistant Staphylococcus epidermidis (MRSA) is a primary pathogen in shunt infections, forming biofilms on catheters.
Purpose of the Study:
- To investigate the immunological response to shunt infections in children with hydrocephalus.
- To explore the role of eosinophils and cerebrospinal fluid (CSF) markers in shunt infections.
Main Methods:
- A study group of 30 children with hydrocephalus and S. epidermidis shunt infection was compared to a control group of 30 children.
- Peripheral blood eosinophil levels were measured in both groups.
- CSF analysis included protein, pleocytosis, interleukins (IL-5, IL-6), and chemokines (CCL26, CCL11, CCL3).
Main Results:
- The highest levels of peripheral blood eosinophils and CSF pleocytosis were observed in the infected group after initial treatment.
- A significant increase in most analyzed CSF interleukins accompanied these findings.
Conclusions:
- CSF pleocytosis following CSF sterilization suggests an allergic reaction to Staphylococcus epidermidis.
- This immunological response may be a key factor in the pathogenesis of shunt infections.
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