Staphylococcus warneri ventriculoperitoneal shunt infection: failure of diagnosis by ventricular CSF sampling

Martínez‐Lage, Juan F.; Azorin, L.; Almagro, María-José

doi:10.1007/s00381-009-1050-0

Cited by 13 publications

(12 citation statements)

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“…Divergences in composition of CSF from these compartments have also been attributed to the diverse location of the infecting focus 6 . Similar differences in ventricular and spinal fluid have been reported in cases of neurocysticercosis, tuberculous and pneumococcal meningitis, and in children with leptomeningeal spread of CNS tumors 4,6,9,14 . Interestingly, Heringer et al have reported one case with negative ventricular and lumbar CSF cultures, in which only the cisternal CSF yielded acid-fast bacilli 6 .…”

Section: Discussionsupporting

confidence: 77%

“…In addition, an LP should not be performed in patients who present with impaired consciousness as cerebral herniation may occur even when neuroimaging has been normal 2 . On the other hand, in patients given a ventriculoperitoneal shunt, CSF analysis is routinely performed via the valve reservoir, given that the analysis of shunt fluid is generally regarded as the most reliable method for the diagnosis of a valve infection 9,11 . In our patients, initial CSF sampling was performed directly from the ventricles at the time of VP shunt insertion, via the valve reservoir or from the external ventricular drain respectively.…”

Section: Discussionmentioning

confidence: 99%

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Normal ventricular-CSF may confound the diagnosis of tuberculous meningitis hydrocephalus

et al. 2011

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Background. The standard procedure for the diagnosis of central nervous system (CNS) infections consists of cerebrospinal fluid (CSF) sampling, which is usually accomplished by a lumbar puncture. However, in some patients presenting with acute hydrocephalus submitted to immediate CSF drainage, the fluid is customarily obtained from the placed draining system. In addition, the CSF obtained from the ventricular and lumbar spaces in some cases may show unusual differences, both in physiological and pathological conditions. Illustrative cases. We report two children who presented with confounding results in the initial studies of their ventricular and lumbar CSF who were subsequently diagnosed with tuberculous meningitis, causing delay in diagnosis and treatment. Aim. By reporting these cases, we wanted to alert the treating physician about the possibility of this discrepancy to avoid the delayed diagnosis and management of the affected patients. Discussion. We comment on the possible pathophysiological mechanisms that may result in this dissociation in ventricular and lumbar CSF composition. Conclusions. Normal results in CSF studies, especially those of the ventricular fluid, do not always rule out the presence of tuberculous meningitis. We suggest obtaining a CSF sample from the lumbar subarachnoid space in doubtful, or suspicious, cases of CNS infection even in the presence of a normal ventricular CSF. KEY WORDS. Cerebrospinal fluid. Lumbar CSF. Ventricular CSF. Bacterial meningitis. Tuberculous meningitis hydrocephalus. Infectious hydrocephalus. LCR ventricular normal: un factor de confusión en el diagnóstico de hidrocefalia por meningitis tuberculosa Resumen

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Normal ventricular-CSF may confound the diagnosis of tuberculous meningitis hydrocephalus

et al. 2011

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“…The second most frequently identified species, S. warneri was isolated from one of the healthcare units and four hospital wards, including cardiology, sickroom of an intensive care unit and an infectious ward, whose patients' immune system may be compromised. This information might be important, as this species was reported to cause infections in hospitalized patients and was also suggested as a cause of, among others, ventricular shunt infections, endocarditis and even sepsis (32,33). One of the most dangerous CoNS, S. haemolyticus was isolated from 4 sites (n = 5) -three hospitals, including the isolation ward of an ICU.…”

Section: Discussionmentioning

confidence: 99%

Assessment of microbiological aerosol concentration in selected healthcare facilities in southern Poland

Stec

Lenart‐Boroń

2019

Cent Eur J Public Health

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Objectives: This study was aimed to assess the concentration of microbial aerosol and species composition of airborne staphylococci in 10 healthcare facilities in southern Poland including primary healthcare units and hospital wards; and to assess whether the selected components of microbial aerosol pose a threat of severe infections to either patients or the personnel. Methods: The study was conducted at monthly intervals over a period of one year. Air samples were collected by MAS-100 sampler. The number of mesophilic bacteria, mould fungi, actinomycetes and staphylococci was determined on general and selective media. The species identification of staphylococci was conducted using API tests for strains that were pre-selected based on macroscopic and microscopic observations. Results: A total number of 1,584 samples were collected during the sampling period. The numbers of airborne microorganisms varied between the examined premises and between the seasons of the year. The observed differences were statistically significant with one exception for actinomycetes and their differences between the examined premises. The concentrations of mesophilic bacteria varied from 5 to 297 CFU/m 3 of air, for Staphylococcus the values ranged from 1 to 96 CFU/m 3 , for fungi-from 1 to 100 CFU/m 3 , and the number of actinomycetes ranged from 7 to 321 CFU/m 3. Ten species of coagulase-negative staphylococci (CoNS) were identified among 55 isolates with S. saprophyticus and S. warneri being the most frequently detected (n = 14 and 13, respectively). S. haemolyticus, which is one of the most common causal agents of nosocomial infections was observed in four facilities (n = 5). Conclusions: The microbial concentrations varied both between the seasons of the year and between the examined facilities. The highest bioaerosol concentrations were observed in most crowded premises. The identified species of staphylococci, although not typically associated with human infections, are common causal agents of nosocomial infections and infections in immunocompromised people.

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Methods The study group involved 30 children with congenital hydrocephalus after shunt system implantation, whose procedures were complicated by S .

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confidence: 99%

Unexpected eosinophilia in children affected by hydrocephalus accompanied with shunt infection

Polis

Zeman

et al. 2018

Childs Nerv Syst

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PurposeThe aim of the article is to describe an immunological reaction to shunt infection in children with hydrocephalus. The main cause of shunt infection involves methicillin resistant Staphylococcus epidermidis (Bhatia et al. Indian J Med Microbiol 35:120–123, 2017; Hayhurst et al. Childs Nerv Syst 24:557–562, 2008; Martínez-Lage et al. Childs Nerv Syst 26: 1795–1798, 2010; Simon et al. PLoS One, 2014; Snowden et al. PLoS One 8:e84089, 2013; Turgut et al. Pediatr Neurosurg 41:131–136, 2005), a bacterial strain which is responsible for the formation of biofilm on contaminated catheters (Snowden et al. PLoS One 8:e84089, 2013; Stevens et al. Br J of Neurosurg 26: 792–797, 2012).MethodsThe study group involved 30 children with congenital hydrocephalus after shunt system implantation, whose procedures were complicated by S. epidermidis implant infection. Thirty children with congenital hydrocephalus awaiting their first-time shunt implantation formed the control group. The level of eosinophils in peripheral blood was assessed in both groups. Cerebrospinal fluid (CSF) was examined for protein level, pleocytosis, interleukins, CCL26/Eotaxin-3, IL-5, IL-6, CCL11/Eotaxin-1, CCL3/MIP-1a, and MBP. Three measurements were performed in the study group. The first measurement was obtained at the time of shunt infection diagnosis, the second one at the time of the first sterile shunt, and the third one at the time of shunt reimplantation. In the control group, blood and CSF samples were taken once, at the time of shunt implantation.ResultsIn the clinical material, the highest values of eosinophils in peripheral blood and CSF pleocytosis were observed in the second measurement. It was accompanied by an increase in the majority of analyzed CSF interleukins.ConclusionCSF pleocytosis observed in the study group shortly after CSF sterilization is presumably related to an allergic reaction to Staphylococcus epidermidis, the causative agent of ventriculoperitoneal shunt infection.

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Staphylococcus warneri ventriculoperitoneal shunt infection: failure of diagnosis by ventricular CSF sampling

Cited by 13 publications

References 12 publications

Normal ventricular-CSF may confound the diagnosis of tuberculous meningitis hydrocephalus

Normal ventricular-CSF may confound the diagnosis of tuberculous meningitis hydrocephalus

Assessment of microbiological aerosol concentration in selected healthcare facilities in southern Poland

Unexpected eosinophilia in children affected by hydrocephalus accompanied with shunt infection

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