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Cerebral cyst infection with Micrococcus sedentarius. Case report
Abstract:
A 7-year-old boy with congenital hydrocephalus and a left septate cerebral cyst presented with a shunt infection due to Micrococcus sedentarius, resistant to all penicillins. The shunt infection was persistent despite several courses of parenteral, intraventricular, and intracyst antibiotics. Evaluation of the ventricular fluid revealed adequate "killing power" against the patient's microorganism. No extracranial focus of infection could be found. Computerized tomographic scanning, along with air ventriculography, identified a noncommunicating area of the cerebral cyst. Only when communication between this location and the rest of the cyst was established were the antibiotics efficacious. Undercirculated areas of cerebrospinal fluid should be sought when shunt infections and ventriculitis persist in spite of adequate parenteral and local therapy in patients with brain cysts.
Insights
Persistent shunt infections in children with congenital hydrocephalus and brain cysts may indicate noncommunicating fluid areas. Establishing communication resolved the infection, highlighting the importance of seeking these under-circulated cerebrospinal fluid spaces.
Area of Science:
- Neuroscience
- Infectious Diseases
- Pediatric Surgery
Background:
- Congenital hydrocephalus and septate cerebral cysts present complex management challenges.
- Shunt infections, particularly with resistant microorganisms like Micrococcus sedentarius, are difficult to treat.
- Standard antibiotic therapies (parenteral, intraventricular, intracyst) were ineffective in this case.
Observation:
- A 7-year-old boy with hydrocephalus and a cystic brain lesion developed a persistent shunt infection.
- Despite adequate antibiotic concentrations and 'killing power' in cerebrospinal fluid, the infection did not resolve.
- Imaging revealed a noncommunicating compartmentalized area within the cerebral cyst.
Findings:
- The persistent shunt infection and ventriculitis were linked to a noncommunicating cystic area.
- Establishing communication between the isolated cyst compartment and the rest of the ventricular system led to antibiotic efficacy.
- Micrococcus sedentarius, resistant to penicillins, was the causative agent.
Implications:
- Undercirculated or compartmentalized cerebrospinal fluid spaces should be investigated in persistent shunt infections.
- Failure to address such anatomical abnormalities can lead to treatment failure.
- This case underscores the importance of comprehensive anatomical evaluation in managing complex pediatric neurosurgical infections.