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Fungal infection of ventriculoperitoneal shunts in children
Abstract:
Infection is still the most common complication of shunt procedures in children. However, fungal infection is still considered to be rare. We found that fungi accounted for 17% of shunt infections (8 of 48) in a retrospective study. All of the patients were premature babies and had received a ventriculoperitoneal shunt because of hydrocephalus. The clinical manifestations were subtle and insidious. The time of onset of infection ranged from 1 month to 1 year after the insertion of the shunt. Examination of the cerebrospinal fluid of infected patients showed mild pleocytosis with an elevated protein concentration. Candida species (including Candida albicans, Candida parapsilosis, and Candida tropicalis) or Torulopsis glabrata were isolated. In all but one case, shunts were removed and systemic therapy with amphotericin B was administered. Amphotericin B was given intrathecally to two patients, who did not respond to systemic therapy. Treatment with fluconazole failed for one patient. We suggest performing fungal cultures in cases of shunt infection, especially those involving premature infants. Extraventricular drainage, systemic therapy with amphotericin B, and insertion of a new shunt remain the principal components of the treatment regimen for fungal shunt infections in children.
Insights
Fungal shunt infections, though rare, are a significant concern in premature infants receiving cerebrospinal fluid shunts. This study highlights their prevalence and suggests fungal cultures for diagnosis and specific antifungal treatments.
Area of Science:
- Pediatric Infectious Diseases
- Neurosurgery
- Mycology
Background:
- Shunt procedures are common for hydrocephalus in children.
- Infections are the most frequent complication of these procedures.
- Fungal shunt infections are considered uncommon.
Observation:
- A retrospective study identified fungi in 17% of pediatric shunt infections (8 of 48).
- All affected patients were premature infants with ventriculoperitoneal shunts for hydrocephalus.
- Infections presented insidiously, with onset 1 month to 1 year post-insertion.
Findings:
- Cerebrospinal fluid analysis revealed mild pleocytosis and elevated protein.
- Candida species and Torulopsis glabrata were the identified fungal pathogens.
- Treatment involved shunt removal and systemic amphotericin B; intrathecal amphotericin B and fluconazole showed limited success.
Implications:
- Fungal cultures should be considered in shunt infections, particularly in premature infants.
- Management requires shunt removal, systemic antifungal therapy (e.g., amphotericin B), and potentially extraventricular drainage.
- Early diagnosis and targeted antifungal treatment are crucial for better outcomes in pediatric fungal shunt infections.