Serological Surveillance of Children with CSF Shunting Devices

Bayston, Roger

doi:10.1111/j.1469-8749.1975.tb03588.x

Cited by 16 publications

(1 citation statement)

References 12 publications

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“…The technology is simple, involving agglutination in microtitre trays. Serum ASET levels rise with age in a predictable manner, and normal ranges have been established 10. The titre is usually <160 in children under 3 years of age.…”

Section: Discussionmentioning

confidence: 99%

The use of the ASET in the diagnosis of ventriculoatrial shunt infection

2012

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BACKGROUNDVentriculoatrial (VA) shunting has been superseded in popularity by the use of the peritoneal route (ventriculoperitoneal (VP)), mainly because of ease of insertion of the latter. However, a substantial number are still used, either as primary insertions or to replace a persistently failing VP shunt. 1 -3 In addition, a large but unknown number of patients with VA shunts remain in the community, usually without neurosurgical follow-up, 4 and may require medical attention at any time.VA shunt infections can be particularly diffi cult to diagnose because unlike VP shunt infections they often present long after shunt insertion with non-specifi c symptoms, and often to a specialty other than neurosurgery. Also, while VP shunt infection is often associated with distal obstruction, VA shunt infection does not usually compromise shunt function. Though Staphylococcus epidermidis is the most common cause of VA shunt infection it is also a universal skin commensal. Blood cultures are often negative or inconclusive and the signifi cance of a growth of S epidermidis can be diffi cult to determine. Ventricular cerebrospinal fl uid (CSF) aspirated from the shunt reservoir can also show no evidence of infection when only the shunt hardware is colonised, and there remains a diagnostic problem.Almost all VA shunt infections are contracted at the time of shunt insertion. S epidermidis is very adherent to shunt tubing, forming a biofi lm inside the shunt catheter, 5 -7 which periodically sheds into the bloodstream, repeatedly inoculating the patient. This causes a rising antibody titre to S epidermidis , which eventually leads to immune complex deposition and the problems that are associated with this, such as shunt nephritis. 8 If a VA shunt is infected for more than a year, immune complex disease can be the presenting problem, but it often manifests with non-specifi c or misleading symptoms such as vague joint or muscle pains, tiredness or skin rash. Here we present a patient with a VA shunt and non-specifi c symptoms and inconclusive laboratory results, where the diagnosis was eventually made with the assistance of serological testing. CASE PRESENTATIONThe patient, a 38-year-old man with a Dandy Walker cyst and shunted hydrocephalus, had required several shunt revisions for malfunction and for infection as a child, the last one before this episode being at the age of nine, since when he had had a VP shunt. He was well until the age of 35, when he presented with headaches and abdominal pain. He underwent several revisions over the next year, but he continued to have abdominal pain so his shunt was revised to a VA shunt. The procedure was straightforward. He was asymptomatic when reviewed 3 months postoperatively. However, 7 months from the time of insertion he presented with severe headaches which were managed symptomatically. His symptoms resolved and he remained well for several months. After a further 4 months he presented with headaches and night sweats, and he was investigated for a possible shunt infection. INVE...

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Section: Discussionmentioning

confidence: 99%

The use of the ASET in the diagnosis of ventriculoatrial shunt infection

2012

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Der frühe serologische Nachweis einer Besiedelung von ventriculoatrialen Shunts mit Staphylococcus epidermidis

Holt

1980

Infection

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Simple quantitative serological tests demonstrating Staphylococcus epidermidis agglutinins and C-reactive protein were used for the early detection of ventriculo-atrial shunt colonization by this organism. Tests in normal children and adults in various age groups throughout life confirmed Bayston's ovservations that those tested attained a titre up to 1:160 TO S. epidermidis agglutinogen. In contrast, the titre in children with colonised shunts and in adults with S. epidermidis endocarditis, both conditions which are usually accompanied by bacteraemia, rose to much higher levels, sometimes up to 1:5120. The routine combination of both tests has proven to be of considerable diagnostic value, particularly in early or recent colonisation.

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

Bayston

Rodgers

1994

Eur. J. Clin. Microbiol. Infect. Dis.

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Seven cases of ventriculoatrial shunt infection with immune complex disease are reported in order to demonstrate the usefulness of measurement of levels of specific antibody to Staphylococcus epidermidis in diagnosis. Blood and cerebrospinal fluid cultures gave misleading results, and there was initial doubt about the diagnosis in all seven cases. All showed grossly elevated titres of antibody to Staphylococcus epidermidis, with raised serum C-reactive protein levels and depressed complement levels. Measurement of antibody to Staphylococcus epidermidis enables the diagnosis of chronic ventriculoatrial shunt infection to be made rapidly and reliably.

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Serological Surveillance of Children with CSF Shunting Devices

Cited by 16 publications

References 12 publications

The use of the ASET in the diagnosis of ventriculoatrial shunt infection

The use of the ASET in the diagnosis of ventriculoatrial shunt infection

Der frühe serologische Nachweis einer Besiedelung von ventriculoatrialen Shunts mit Staphylococcus epidermidis

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

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