Role of serological tests in the diagnosis of immune complex disease in infection of ventriculoatrial shunts for hydrocephalus

Bayston, Roger; Rodgers, J

doi:10.1007/bf01972001

Cited by 13 publications

(9 citation statements)

References 9 publications

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“…The low complements, as discussed previously, may represent activation of the classical pathway as the disease unfolds [69]. For disease screening and diagnostic purposes, Bayston et al have proposed the use of Anti Staphylococcus Epidermidis Titer (ASET) after they demonstrated that ASET rises predictably in patients with VA shunts colonized by Staphylococcus epidermidis [61, 76, 77]. While the ASET is a welcome addition to the diagnostic armamentarium, no single symptom, sign, or lab finding should be considered in isolation when shunt nephritis is suspected.…”

Section: Discussionmentioning

confidence: 99%

Delayed Manifestation of Shunt Nephritis: A Case Report and Review of the Literature

Babigumira

Huang

Werner

et al. 2017

Case Reports in Nephrology

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We present an unusual case of shunt nephritis in a 39-year-old male who presented 21 years after placement of a ventriculoperitoneal (VP) shunt. He complained of fevers, headaches, dizziness, and urticarial plaques on arms, trunks, and legs and was found to have anemia, low complement levels, elevated serum creatinine, proteinuria, and new onset microhematuria. Blood and urine cultures were negative. Renal biopsy showed features of acute tubulointerstitial nephritis attributed to vancomycin use. Glomeruli showed increased mesangial hypercellularity and segmental endocapillary proliferation. Immunofluorescence showed focal IgM and C3 staining. Electron microscopy revealed small subendothelial electron-dense deposits. Symptoms and renal insufficiency appeared to improve with antibiotic therapy. He was discharged and readmitted 2 months later with similar presentation. CSF grew Propionibacterium acnes and shunt hardware grew coagulase-negative Staphylococcus. He completed an intravenous antibiotic course and was discharged. On 1-month follow-up, skin lesions persisted but he was otherwise asymptomatic. Follow-up labs showed significant improvement. We did a brief systematic review of the literature on shunt nephritis and report our findings on 79 individual cases. In this review, we comment on the presentation, lab findings, pathological features, and management of this rare, potentially fatal, but curable disease entity.

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Section: Discussionmentioning

confidence: 99%

Delayed Manifestation of Shunt Nephritis: A Case Report and Review of the Literature

Babigumira

Huang

Werner

et al. 2017

Case Reports in Nephrology

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“…Blood culture is also of limited value, except for cases of vascular shunts, where it is positive in up to 90% of infections [6]. The level of specific antibodies against Staphylococcus epidermidis is also a useful alternative for the diagnosis of chronic ventriculoatrial shunt-related infections [62]. Abdominal ultrasound may be helpful in the identification of CSF collections.…”

Section: Diagnosismentioning

confidence: 99%

Cerebrospinal fluid diversion devices and infection. A comprehensive review

Gutiérrez-González

Boto

Pérez-Zamarrón

2011

Eur J Clin Microbiol Infect Dis

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Hydrocephalus is a common neurosurgical disease affecting approximately 40 per 100,000 people. Cerebrospinal fluid diversion devices are essential in the management of this pathology. These devices include internal shunts and external ventricular drains. Infection is the most significant complication resulting from the high frequency of appearance and the consequences it involves, since it is associated with increased morbidity and mortality. It also involves increased hospital costs (approximately 40,000 euro per episode). In the present report the authors make a comprehensive review of cerebrospinal fluid diversion devices and their most important complication: infection. The authors make special emphasis on the epidemiology, aetiology, pathogenesis, risk factors, symptoms and signs, diagnosis, treatment and prevention of infection.

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“…We made this shift because VA shunts have been associated with infrequent yet potentially catastrophic complications. These included endocarditis/atrial thrombi [11], immune complex disease [12] and shunt nephritis [13]. Essentially, a VA shunt is a chronic indwelling intravascular foreign body, and even low-grade infection will produce chronic bacteremia.…”

Section: Discussionmentioning

confidence: 99%

Abdominal Cerebrospinal Fluid Pseudocyst: A Complication of Ventriculoperitoneal Shunt in Children

1998

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The present paper is a retrospective analysis of 27 consecutive patients, treated for abdominal cerebrospinal fluid (CSF) pseudocyst at the Children’s Memorial Hospital in the years 1991–1996. This series is compared to the previous experience from our institution. Treatment consisted of the removal of the ventriculoperitoneal (VP) shunt and placement of an external ventricular drain. Antibiotics were administered intravenously for 10 days. The cysts were aspirated intraoperatively in 9 patients and postoperatively with ultrasound guidance in 3 patients, while they resolved spontaneously in 15 others. In 21 of 27 cases (78%), the shunt could be reinserted into the abdomen in a new location. Four patients had a ventriculopleural shunt, and in 2 patients, a ventriculoatrial shunt was inserted. Forty-four percent of the patients had a positive culture on presentation. The positive culture rate was 77% for those 4 years old and younger and only 28% for those aged 5 and above (p = 0.03). We conclude that abdominal CSF pseudocysts are resolved by externalizing the shunt. A VP shunt can be safely reinserted in the majority of the patients. Infection, while an important factor, is not likely to account for all cases of pseudocyst.

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Role of serological tests in the diagnosis of immune complex disease in infection of ventriculoatrial shunts for hydrocephalus

Cited by 13 publications

References 9 publications

Delayed Manifestation of Shunt Nephritis: A Case Report and Review of the Literature

Delayed Manifestation of Shunt Nephritis: A Case Report and Review of the Literature

Cerebrospinal fluid diversion devices and infection. A comprehensive review

Abdominal Cerebrospinal Fluid Pseudocyst: A Complication of Ventriculoperitoneal Shunt in Children

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