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Fungal Infections of Cerebrospinal Fluid Shunt in Pediatric Patients: A Systematic Literature Review With a Case
Natalia Kardas1, Natalia Wyroba1, Ryszard Sordyl1
1Department of Pediatric Neurosurgery, Medical University of Silesia in Katowice, Katowice, Poland.
Background:
The standard treatment of hydrocephalus consists of the implantation of a cerebrospinal fluid (CSF) shunt. Infection of the CSF shunts affects 5%-15% of the patients, primarily due to bacterial pathogens, with rare cases involving fungi. This study aimed to systematically review the clinical characteristics, diagnostic approaches, treatment strategies, and outcomes of fungal CSF shunt infections in children.
Methods:
A systematic review was conducted according to the PRISMA guidelines. PubMed, Scopus, Web of Science, Mendeley, and Cochrane Library databases were searched for studies on fungal CSF shunt infection in children, published from inception until 6 September 2024.
Results:
A total of 26 studies reporting on 38 pediatric patients were found eligible, including our institutional case; a total of 39 patients were analyzed. Candida genus remained the most common causative agent (76.92%), with Candida albicans being the most prevalent (58.97%). CSF culture confirmed the infection in 77.78% of the cases. Amphotericin B was the most frequently used antifungal agent in monotherapy (55.56%). The primary route of administration was intravenous (92.86%), while intraventricular and intrathecal administration were used in 27.59%, and 20.00% of patients, respectively. Notably, 5.13% patients underwent fungal vegetation removal. Both the recurrence and the mortality rates were 10.81%.
Conclusions:
Fungal CSF shunt infections pose significant therapeutic challenges, necessitating the implementation of a broad treatment strategy to achieve successful outcomes. Intraventricular and intrathecal antifungal drug administration may become necessary, especially in persistent fungal infections.
Insights
Fungal cerebrospinal fluid (CSF) shunt infections in children are challenging. Treatment requires broad strategies, including intraventricular and intrathecal antifungals for persistent cases, with significant recurrence and mortality rates.
Area of Science:
- Pediatric Infectious Diseases
- Neurosurgery
- Medical Mycology
Background:
- Cerebrospinal fluid (CSF) shunts are standard for hydrocephalus treatment.
- CSF shunt infections occur in 5%-15% of patients, predominantly bacterial, but fungal infections are rare.
- This review focuses on fungal CSF shunt infections in pediatric patients.
Purpose of the Study:
- To systematically review the clinical characteristics of fungal CSF shunt infections in children.
- To analyze diagnostic approaches, treatment strategies, and outcomes.
- To identify challenges and necessary therapeutic interventions.
Main Methods:
- Systematic review adhering to PRISMA guidelines.
- Searched PubMed, Scopus, Web of Science, Mendeley, and Cochrane Library databases.
- Included studies on pediatric fungal CSF shunt infections published up to September 6, 2024.
Main Results:
- Analyzed 39 pediatric patients from 26 studies.
- Candida species, particularly Candida albicans, were the most common pathogens (76.92%).
- Amphotericin B was the primary monotherapy (55.56%), with IV, intraventricular, and intrathecal routes used. Recurrence and mortality rates were 10.81%.
Conclusions:
- Fungal CSF shunt infections present significant therapeutic challenges.
- Broad treatment strategies are essential for successful outcomes.
- Intraventricular and intrathecal antifungal administration may be crucial for persistent infections.
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