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Propionibacterium acnes: A Difficult-to-Diagnose Ventriculoperitoneal Shunt Infection. Case Report
Dzmitry Kuzmin1, Guenther C Feigl1,2,3
1Department of Neurosurgery, General Hospital Bamberg, Bamberg, Germany.
Background:
Ventriculoperitoneal (VP) shunt infections are a fairly common complication in both the early and late postoperative periods. Sometimes diagnosis is difficult despite the fact that infection is often accompanied by clinical symptoms. Furthermore, pathogenic bacteria can be detected in the cerebrospinal fluid.
Method:
We describe a case of chronic VP shunt infection in a 24-year-old female patient who was operated on for posterior fossa pilocytic astrocytoma and needed a VP shunt. The infection revealed itself 5 years after shunt implantation with nonspecific symptoms, and it took approximately 2 years to make a correct diagnosis. Meanwhile, the patient's condition became critical. The infection was caused by Propionibacterium acnes, which is capable of forming biofilms on implants, and which is difficult to identify due to the peculiarity of its cultivation.
Result:
When the bacterium was identified, the shunt was replaced and antimicrobial therapy was performed, after which the patient's condition improved dramatically and she got back to her normal life.
Conclusions:
This case shows how difficult the diagnosis of VP shunt infection can be and what clinical significance it can have for the patient.
Insights
Diagnosing chronic ventriculoperitoneal (VP) shunt infections, like this Propionibacterium acnes case, can be challenging. Prompt identification and treatment are crucial for patient recovery and improved outcomes.
Area of Science:
- Neurosurgery
- Infectious Diseases
- Medical Diagnostics
Background:
- Ventriculoperitoneal (VP) shunts are essential for managing cerebrospinal fluid disorders.
- Shunt infections pose significant risks, complicating both early and late postoperative care.
- Subtle clinical presentations can mask serious infections, hindering timely diagnosis.
Observation:
- A 24-year-old female with a history of posterior fossa pilocytic astrocytoma developed a chronic VP shunt infection 5 years post-implantation.
- The infection, caused by *Propionibacterium acnes*, presented with nonspecific symptoms, delaying diagnosis for 2 years.
- *Propionibacterium acnes* is known for biofilm formation on implants and challenging cultivation, contributing to diagnostic delays.
Findings:
- The chronic VP shunt infection was successfully treated by shunt replacement and targeted antimicrobial therapy.
- Identification of *Propionibacterium acnes* was key to initiating effective treatment.
- The patient experienced a dramatic recovery and returned to normal life after intervention.
Implications:
- This case highlights the diagnostic challenges associated with chronic VP shunt infections, particularly those caused by difficult-to-cultivate bacteria.
- Delayed diagnosis can lead to critical patient conditions, underscoring the need for heightened clinical suspicion.
- Effective management involves accurate pathogen identification, surgical intervention, and appropriate antimicrobial therapy.
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