Infection of a ventriculoatrial shunt with phenotypically variable Staphylococcus epidermidis masquerading as polymicrobial bacteremia due to various coagulase-negative Staphylococci and Kocuria varians.
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The diagnosis of bloodstream infection with coagulase-negative staphylococci is frequently based on the isolation of the same organism from more than one blood culture. Phenotypic variation is a common characteristic of pathogenic strains of Staphylococcus epidermidis which may affect species identification by the microbiology laboratory. We describe a patient with a new onset of nephritis and gram-positive bacteremia. Gram-positive cocci grew in multiple blood cultures and were identified by the Vitek 2 system as Kocuria varians, Staphylococcus hyicus, and S. epidermidis. Bacterial isolates grew on blood agar and Congo red agar plates as two distinct morphotypes and exhibited phenotypic variation. Neither morphotype could be identified by the API-Staph assay. Cellular fatty acid analysis identified one of the morphotypes as S. epidermidis but could not identify the other morphotype. All isolates were found to be identical by pulsed-field gel electrophoresis, and both colonial morphotypes were identified as S. epidermidis by 16S ribosomal gene sequencing. Phenotypic variation of S. epidermidis may affect identification to the species level by phenotype-based identification systems. Caution should be exercised when differentiating between true infection and contamination based on strain identification. (+info)
Analysis of retained ventricular shunt catheters.
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To identify the causes of ventricular shunt catheter retention, 42 shunt removals in 28 patients in our neurosurgical clinic from 1982 to 1991 were analyzed. The mean patient age was 13.8 years (2 mos-78 yrs), and mean shunt duration was 20.1 months (0.5-94 mos). There were nine retained ventricular catheters, including five with obstruction of the ventricular catheter. Shunt duration was significantly longer compared with the unretained group. Three retained ventricular catheters were stained by HE for histological examination. Light microscopy showed the inner lumen of catheters filled with granulomatous connective tissue and reactive glial tissue, and giant cell reaction to silicone material. Scanning electron microscopy of two catheters found peeling on the inner surface of the catheter, evidence of aging of the material. Granulomatous connective tissue and glial tissue reaction to aged silicone are suggested as the cause of catheter retention. (+info)
CSF galanin and cognition after shunt surgery in normal pressure hydrocephalus.
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BACKGROUND: "Normal" pressure hydrocephalus (NPH) is associated with injury to neurotransmitter and neuropeptide systems that recovers after surgery. This could be linked to changes in galanin, a neuropeptide with inhibitory effects on basal forebrain cognitive function. OBJECTIVE: To examine changes in CSF galanin concentrations in patients with normal pressure hydrocephalus undergoing shunt surgery, and to investigate the relation between these changes and cognitive functioning. METHODS: Eight patients underwent surgery for idiopathic normal pressure hydrocephalus. Lumbar CSF galanin determinations, cognitive status, and clinical status were quantified before operation and six months after. Cognition was assessed by an extensive battery of tests measuring attention, memory, speed of mental processing, visuospatial function, and frontal lobe function. RESULTS: CSF galanin concentration decreased after surgery. This reduction correlated with improved clinical and cognitive functioning, specifically with attention and visuomotor speed, visuoconstructive and frontal functioning, and clinical status according to the NPH scale, including the sphincter and cognitive components. CONCLUSIONS: The cognitive and clinical improvement after shunt implantation correlated with CSF galanin levels, suggesting that the distribution or function of this agent involves cerebral structures that have some potential for recovery. In this study, galanin was related to several cognitive functions that may be associated with the fronto-subcortical deficits underlying cognitive dysfunction in normal pressure hydrocephalus. (+info)
Peritoneal bypass in the treatment of hydrocephalus: historical review and abdominal complications.
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The development of intraperitoneal shunting systems is presented chronologically and a review is made of the wide variety of intraperitoneal complications which have occured to date. (+info)
Entrapment of the temporal horn: a form of focal non-communicating hydrocephalus caused by intraventricular block of cerebrospinal fluid flow--report of two cases.
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In two cases of entrapment of the temporal horn, computed tomography demonstrated the typical appearance of a comma-shaped homogeneous area isodense with water surrounded by a periventricular low-density area. The cause was probably choroid plexitis resulting in obstruction of the cerebrospinal fluid pathway at the atrium. External drainage followed by shunt emplacement is indicated. (+info)
Cerebellar astrocytoma with repeated episodes of fourth ventricle isolation causing peritoneal shunt tube obstruction--case report.
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A 9-year-old girl underwent total removal of a cerebellar astrocytoma complicated by hydrocephalus after postoperative meningitis, requiring a ventriculoperitoneal shunt. Five months later, headache, vomiting, and gait disturbance appeared and computed tomography detected enlarged fourth ventricle. A fourth ventriculoperitoneal shunt resulted in immediate relief of all symptoms. After 2 months, obstruction of the peritoneal tube required shunt reconstruction. This recurred three times in 8 months. At the last operation, tumor cells were detected in the cerebrospinal fluid and the substance clogging the tube. This suggested that the tumor had recurred and clogging by tumor cells had caused the repeated episodes of isolated fourth ventricle. Radiation therapy prevented further shunt obstruction and achieved remission of all signs and symptoms. (+info)
Choroid plexus tumor in a child.
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A 5-month-old infant is reported who presented with fever, nonspecific symptoms, a rapidly enlarging head, and a regression in motor development. Investigations subsequently confirmed the diagnosis of a choroid plexus papilloma. (+info)
Long-term outcome in open spina bifida.
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BACKGROUND: Doctors need reliable data on outcome in order to help parents faced with difficult decisions about termination of an affected pregnancy or treatment after birth. AIM: To determine survival, health and lifestyle at the mean age of 30 years in a complete cohort of adults born with open spina bifida. DESIGN OF STUDY: Prospective cohort study. PARTICIPANTS: Well-documented cohort of 117 consecutive cases of open spina bifida whose backs were closed non-selectively at birth between 1963 and 1971. METHOD: Survivors (age range = 26 to 33 years) were surveyed by postal questionnaire and telephone interview. The main outcome measures were the health, independence and lifestyle of the survivors in terms of living in the community, driving a car and working in open employment. RESULTS: Ascertainment was 100%. Sixty (51%) had died, mainly the most disabled. Of the 57 survivors, 84% had a cerebrospinal fluid (CSF) shunt, 70% had an IQ of 80 or more, 37% lived independently in the community, 39% drove a car, 30% could walk more than 50 metres and 26% were in open employment. However one-third (19) still needed daily care, three were on respiratory support, two were blind, two had diabetes mellitus, and one was on dialysis. Mortality, disability and achievement reflected the neurological deficit that had been recorded in infancy in terms of sensory level. Attainment and independence were reduced in those who had needed revision of CSF shunt. CONCLUSION: The survivors in this unselected cohort showed a wide range of outcome from apparent normality to very severe disability. This reflected both the extent of their original neurological deficit and events in the history of their CSF shunt. (+info)