Candida Infection of Cerebrospinal Fluid Shunt Devices: Report of Two Cases and Review of the Literature

Montero, Á.; Romero, Jesús; Vargas, Juan A.; Regueiro, C.A.; Sánchez-Aloz, G.; Prados, F. De; Torre, Alejandro de la; Aragón, G.

doi:10.1007/s007010050009

Cited by 46 publications

(20 citation statements)

References 29 publications

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“…These include indwelling catheters, steroids, immunosuppression, malignancy, cerebrospinal fluid leakage and bowel perforation or abdominal surgery [1,3,4,11,[14][15][16]. Prematurity and the use of prior antibiotics have also been identified as risk factors, and are congruent with our observations.…”

Section: Discussionsupporting

confidence: 84%

See 1 more Smart Citation

Candida albicans ventriculoperitoneal shunt infections: Immunocompetent preterm pediatric case series and an extensive review of literature

Bhatti¹,

Parekh²,

Amanullah³

et al. 2017

Pediatr Dimensions

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Cerebrospinal fluid shunt devices are increasingly being used for decompression, and despite excellent results, obstruction and infection are concerning complications, with underlying fungal etiology a rare consideration. In this study, we focus on pediatric shunt infections caused by Candida albicans in an extensive literature review and by reporting two additional cases. Very limited information regarding diagnosis and treatment of the Candidal shunt infections is available. Prematurity and use of broad spectrum antibiotics have been postulated as risk factors, and a CSF analysis prior to surgical placement of the shunt should be implemented as standard practice. Based on our cases, we suggest establishing the diagnosis based on a single positive fungal culture, and to initiate with intravenous and intraventricular antifungal therapy for two weeks, switching to oral antifungal medication for a total of 43 days in an outpatient setup without immediate ventriculoperitoneal shunt removal.

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Section: Discussionsupporting

confidence: 84%

“…Generally, treatment includes shunt removal, administration of antifungal therapy and placement of a new shunt [2,6,16]. However, our cases were managed differently.…”

Section: Discussionmentioning

confidence: 89%

Candida albicans ventriculoperitoneal shunt infections: Immunocompetent preterm pediatric case series and an extensive review of literature

Bhatti¹,

Parekh²,

Amanullah³

et al. 2017

Pediatr Dimensions

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“…Obstruction and infections are the two most common complications, with infection occurring in 6 to 15% patients with these devices (73,99). Candida is the causative agent in 1% of these infections (99).…”

Section: Ventriculoperitoneal Shuntsmentioning

confidence: 99%

“…Risk factors for Candida shunt infections and meningitis include the use of broad-spectrum antibiotics, prior or concurrent bacterial meningitis, cerebrospinal fluid leakage (35,82,99), bowel perforation and/or abdominal surgery (99), steroids, and indwelling catheters (73).…”

Section: Ventriculoperitoneal Shuntsmentioning

confidence: 99%

Candida Infections of Medical Devices

2004

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The number of indwelling medical devices is escalating, and an increasing proportion of device-related infections are being caused by Candida spp. Candida spp. produce biofilms on synthetic materials, which facilitates adhesion of the organisms to devices and renders them relatively refractory to medical therapy. Management of device-related Candida infections can be challenging. Removal of the infected device is generally needed to establish cure of Candida infections of medical devices. However, since the pathogenesis of Candida bloodstream infection is complicated, more studies are necessary to determine the role of catheter exchange in patients with both gastrointestinal tract mucositis and indwelling catheters. The medical and economic impact of these infections is enormous

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“…Sık saptanmamakla birlikte, fungal infeksiyon riskinin arttığı koşullarda (geniş spektrumlu antibiyotik veya steroid kullanımı, parenteral beslenme, immü-nosüpresyon vb.) bu etkenlerle karşılaşmak mümkündür (25).…”

Section: Etyolojiunclassified

Cerebrospinal Fluid Shunt Infections

Öncü¹

2010

Klimik Dergisi

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ÖzetHidrosefali tedavisinde kullanılan medikal ve cerrahi tedaviler arasında şant, uygulaması en çok tercih edilendir. Beyin-omurilik sıvısı (BOS), şant ile vücut dışına ya da seröz boşluklardan birine yönlendirilerek kafaiçi basıncının azaltılması sağlanmaktadır. Bu cihazların kullanımı sırasında ortaya çıkabilecek komplikasyonlardan biri şantın infeksiyonudur. Ortalama %5-15 sıklığında saptanan şant infeksiyonlarına neden olan etkenler çoğunlukla deri normal fl orasından kaynaklanmaktadır. Cerrahi işlem sıra-sında veya yara iyileşmesi sürecinde mikroorganizmaların şanta bulaşması infeksiyon gelişmesinde en bilinen yoldur. Hastada saptanan klinik belirtiler kullanılan şant tipine göre farklılıklar gösterebilmektedir. Ventrikülo-peritoneal (VP) şant infeksiyonunda karın ağrısı ön planda iken, ventrikülo-atriyal (VA) şant infeksiyonunda ateş en belirgin belirtidir. Şant infeksiyonu düşü-nülen hastalarda BOS'un hücresel, biyokimyasal ve mikrobiyolojik analizleri yapılmalıdır. İnfeksiyon tanısı konulan hastalarda antibiyotik tedavisi ile birlikte şantın revizyonu altın standard yaklaşımdır. Sistemik antibiyotik tedavisi yanında indikasyonu olan vakalarda intraventriküler antibiyotik uygulanması söz konusudur. Şant infeksiyonlarından korunmanın en etkili yolu, cerrahi alan infeksiyonlarını önlemek için gerekli prensiplere maksimum düzeyde uyulmasıdır. Klimik Dergisi 2010; 23(3): 77-82.Anahtar Sözcükler: Beyin-omurilik sıvısı şantları, infeksiyon. AbstractShunt is the most common approach among medical and surgical treatment modalities for treating hydrocephalus. The main purpose of the shunt is to reduce intracranial pressure by draining the cerebrospinal fl uid (CSF) from the ventricles. Infection is one of the serious complications and it develops in approximately 5-15% of the inserted devices. The microorganisms responsible for the shunt infection usually arise from the normal fl ora of the skin. During the surgical procedure and healing period, microorganisms residing in skin may adhere to the shunt and start the infection. The clinical symptoms may differ according to the type of shunt used. Abdominal pain is the most common complaint in patients with infected ventriculo-peritoneal (VP) shunt. On the other hand, fever is the leading symptom in ventriculo-atrial (VA) shunt infection. Other than clinical signs, biochemical and microbiological analysis of CSF are necessary to diagnose shunt infection. The gold standard of treatment is the usage of antibiotics with shunt revision. In addition to parenteral antibiotics, intraventricular administration of antibiotics may be an essential part of the treatment. The most effi cient way to avoid shunt infection is to follow the strict rules for preventing surgical site infections.

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Candida Infection of Cerebrospinal Fluid Shunt Devices: Report of Two Cases and Review of the Literature

Cited by 46 publications

References 29 publications

Candida albicans ventriculoperitoneal shunt infections: Immunocompetent preterm pediatric case series and an extensive review of literature

Candida albicans ventriculoperitoneal shunt infections: Immunocompetent preterm pediatric case series and an extensive review of literature

Candida Infections of Medical Devices

Cerebrospinal Fluid Shunt Infections

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