Ventricular cerebrospinal fluid eosinophilia in children with ventriculoperitoneal shunts

Abstract

To determine the significance of cerebrospinal fluid (CSF) eosinophilia, the charts of 106 patients treated with shunt-related procedures during the calendar year 1985 were reviewed. Sixty-nine patients presented for a shunt revision; their charts were retrospectively reviewed from the time of shunt insertion until January, 1988. The remaining 37 patients had a ventriculoperitoneal shunt inserted during the study period and were subsequently followed to January, 1988. A total of 558 shunt-related procedures were performed on these patients during the study period, with a mean follow-up period of 6.9 years. The infection rate was 3.8%. Eosinophilia was diagnosed when eosinophils accounted for 8% or more of the total CSF white blood cell count. Ventricular CSF eosinophilia occurred in 36 patients sometime during their clinical course. These 36 patients required a mean of 8.5 shunt revisions, while the remaining patients required a mean of 2.5 revisions (p less than 0.001). Shunt infections were also more frequent in patients with eosinophilia (p less than 0.01). In no case was peripheral eosinophilia or a parasitic infection present. This study demonstrates that CSF eosinophilia is common in children with shunts. Children with this laboratory finding will experience more shunt failures. In addition, the new appearance of eosinophilia in the CSF of a patient with a shunt in place suggests the possibility of a shunt infection.

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis*

“…CSF white blood cell counts and lactate concentrations were normal in approximately 20% of episodes in one study of adults with shunt-associated infection [14]. CSF eosinophilia (>8% of the differential count) has been associated with an indolent infection [57]. Using a looser definition of eosinophilia (ie, >1% of the differential count), another analysis noted a correlation of eosinophilia with CSF infection but also with subcutaneous (not transcutaneous) CSF extravasation, blood in the CSF, younger age at shunt insertion, and intraventricular hemorrhage as a cause of the hydrocephalus [58].…”

Update on Eosinophilic Meningoencephalitis and Its Clinical Relevance

“…CSF eosinophilia is present in up to 30% of children with an intraventricular shunt. This measurement must be taken as an indicator of treatment malfunction and/or an infectious complication (106,283). In addition, contrast media for myelography, like iodized oil, may induce eosinophilic meningitis in some patients (124,140,182,183).…”

A Case of Cerebrospinal Fluid Eosinophilia Associated with Shunt Malfunction

“…Traynelis et al [13]demonstrated the presence of discontinuous sheets of inflammatory cells, lipidized macrophages and multinucleated foreign-body giant cells upon microscopic examination following shunt tube removal. Tung et al [14]suggested that patients with CSF eosinophilia undergo shunt replacement more frequently than those without eosinophilia based on his study of 36 patients. This finding is probably related to a higher frequency of shunt infections in patients with CSF eosinophilia.…”