The diagnostic importance of eosinophil granulocytes in the CSF of children with ventricular-peritoneal shunt systems

Wiersbitzky, S; Ahrens, Norbert; Becker, T; Panzig, B; Abel, John J.; Stenger, R. D.

doi:10.1111/j.1600-0404.1998.tb00637.x

Cited by 14 publications

(8 citation statements)

References 12 publications

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“…Unlike the case of Ellis et al [14], our patient did not have CSF eosinophilia, which is normally a diagnostic marker of allergic reactions to shunts [19] or shunt obstruction due to inflammatory mass, but only a local foreign body reaction to the shunt which made the presence of the shunt intolerable. We suggest that, when managing shunt failure, silicone intolerance should be differentiated from silicone allergy and the more common causes of shunt failure, infection and blockage, in order to avoid repeated and unnecessary shunt revisions.…”

Section: Discussionmentioning

confidence: 55%

Foreign Body Granuloma Secondary to Ventriculo-Peritoneal Shunt: A Rare Scenario with a New Insight

Millward

Rosa²,

Williams³

et al. 2013

Pediatr Neurosurg

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Ventriculo-peritoneal shunts are used extensively for the management of hydrocephalus and frequently present with complications such as shunt blockage and infection. Cerebrospinal fluid (CSF) eosinophilia and allergic responses to the shunt itself are rare, poorly understood but increasingly recognised complications. Here, the authors describe a child who required multiple shunt revision surgeries due to extensive scalp tenderness overlying the shunt tubing and persistent severe headaches despite having a normal working shunt and no CSF infection or eosinophilia. Histological investigation of excised tissue during the last shunt revision demonstrated fibrosis with scar tissue and chronic inflammatory infiltrate with foreign body giant cells and few abortive granulomata. This was felt to represent a foreign body reaction to the shunt. A hypoallergenic ‘extracted' shunt was trialled (extracted Delta® valve and extracted ventricular and peritoneal catheters; Medtronic) and the child has had no further shunt revisions and is currently asymptomatic 1 year after the insertion.

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Section: Discussionmentioning

confidence: 55%

Foreign Body Granuloma Secondary to Ventriculo-Peritoneal Shunt: A Rare Scenario with a New Insight

Millward

Rosa²,

Williams³

et al. 2013

Pediatr Neurosurg

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“…Bacterial infections with S. epidermidus and Propionibacterium acnes have been associated with CSF eosinophilia [9,11]. Two patients with an allergy to latex and 1 with presumed allergy to a rifampin- and minocycline-impregnated ventriculoperitoneal catheter had extremely elevated eosinophil counts in the CSF [8,14,15].…”

Section: Discussionmentioning

confidence: 99%

“…In previous studies, eosinophilia in the CSF of patients with ventriculoperitoneal shunts has been found to be a predictor of shunt malfunction and was associated with shunt infection, CSF extravasation, blood in the CSF and posthemorrhagic hydrocephalus [9,10,11]. Eosinophils are produced in the bone marrow from pluripotent stem cells in response to interleukin (IL)-3, granulocyte-macrophage colony-stimulating factor and, most importantly, IL-5 [6].…”

Section: Discussionmentioning

confidence: 99%

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Eosinophil Activation in the Cerebrospinal Fluid of Children with Shunt Obstruction

Heidemann

Fiore

Sood³

et al. 2010

Pediatr Neurosurg

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Objective: To determine if eosinophils are activated to release the cationic proteins, eosinophil cationic protein (ECP) and eosinophil-derived neurotoxin (EDN) in shunt obstruction, and to find out if these proteins are associated with ventriculoperitoneal shunt failure. Patients and Methods: This was a prospective observational study carried out in a 20-bed tertiary pediatric intensive care unit. Patients studied were children aged 0–18 years with suspected ventriculoperitoneal shunt malfunction requiring shunt revision. No interventions were performed. Cerebrospinal fluid (CSF) was analyzed for cell count and EDN and ECP concentrations. Patients were prospectively followed for 6 months to evaluate shunt failure. Results: In a 2-month period, 56 shunt revisions were performed on 56 children. Three children had culture-proven infection. Eosinophilia, defined as ≧5% eosinophils in the CSF, was present in 9 out of 53 children (17%). The 3 patients with infection did not have eosinophilia and were excluded from further analysis. Patients with CSF eosinophilia had higher concentrations of ECP (1.38 ± 0.66 vs. 0.41 ± 0.15 ng/ml; p = 0.013) and EDN (16.94 ± 5.83 vs. 4.69 ± 1.33 ng/ml; p = 0.011). Patients with CSF eosinophilia did not have more ventriculoperitoneal shunt revisions within 6 months (6 of 9) compared to those who did not have eosinophilia (21 of 44; p = 0.50). However, patients with higher levels of ECP in the CSF required more shunt revisions within 6 months of their surgeries (p < 0.05). Conclusions: In patients with malfunctioning ventriculoperitoneal shunts, CSF eosinophils are activated and release ECP and EDN. The presence of ECP is associated with a shorter shunt life.

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“…CSF eosinophilia has been reported to be a strong indicator of shunt pathology (Bosch and Oehmichen, 1978;Tzvetanova and Tzekoc, 1986;Vinchon et al, 1992;Wiersbitzky et al, 1998). Although specific, the finding of CSF eosinophilia has low sensitivity.…”

Section: Shunt Pathologymentioning

confidence: 97%

How to Interpret a CSF—The Art and the Science

Connell

Curtis

Advances in Experimental Medicine and Biology

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The diagnostic importance of eosinophil granulocytes in the CSF of children with ventricular-peritoneal shunt systems

Cited by 14 publications

References 12 publications

Foreign Body Granuloma Secondary to Ventriculo-Peritoneal Shunt: A Rare Scenario with a New Insight

Foreign Body Granuloma Secondary to Ventriculo-Peritoneal Shunt: A Rare Scenario with a New Insight

Eosinophil Activation in the Cerebrospinal Fluid of Children with Shunt Obstruction

How to Interpret a CSF—The Art and the Science

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