Shunt Infection

Shunt Infection General Information

Infections are difficult conditions because the agent that causes them may develop resistance to certain treatment options. In medical terms, shunt is the passage or hole which allows the movement or enhances the movement of fluid from one part of the body to another. There are two forms of shunts: congenital and acquired (may be either mechanical or biological). We can offer some examples of shunts: cerebral, cardiac, porto-systemic, pulmonary or portal caval/portcaval. In this first chapter of our presentation we will focus on the main pieces of information about Shunt Infection that should be known by all the patients who suffer from this type of medical condition. Patients must be very well informed in what concerns this disease so that they notice it in time, before it reaches a severe stage and causes severe complications that could threaten their life.

This medical disorder is caused by various classes of pathogens, for example: coagulase-negative staphylococci (such as staphylococcus aureus) – in 50-55% of the cases, gram negative bacteria (such as Candida species, or propionibacterium species) – in 30% of the cases and streptococcal species. The most common causes of CSF Shunt Infection are normal skin commensals, as it is known that the patients are also at a high risk of developing meningitis caused by traditional pathogens (H. influenzae, N. meningitis, S. pneumoniae etc). Rarer organisms that cause this type of infection are the diphethenoids. The management of Shunt Infection is questionable and remains a source of intense controversy. The treatment options and the signs and symptoms of this medical condition depend on the type of bacteria that causes the infection.

Shunt Infection Symptoms

The signs and symptoms of a medical disorder help both the doctor and the patient to notice the problem and to discover and treat it in time, before more severe complications appear and slow down the process of healing. Shunt Infection is a type of disease characterized by specific signs and symptoms that are experienced by almost all the patients and vary from mild, to moderate and serious. Some patients may accuse particular and unique manifestations, because, as we all know, our immune system reacts in a different way when it is attacked by harmful agents. All the signs and symptoms that we will enumerate depend on the organism responsible with the occurrence of the infection. If you still have questions about the clinical manifestations of Shunt Infections we advise you to contact your health care provider or any other trained specialist.

Fever usually occurs in more than 95% of the cases along with malfunction that causes raised intracranial pressure. This determines the appearance of other disturbing symptoms, for example: altered mental status, headaches, dizziness, nausea and vomiting, faintness etc. The traditional meningeal signs are not very common. Sometimes, tenderness of skin and erythema are present. Other common signs and symptoms may include one or more of the following: shunt tract inflammation, pain felt in the abdominal area, hepatosplenomegaly, localized wound, perforated viscus, right sided endocarditis or pseudocysts. Less common symptoms of Shunt Infection are considered the following: intra-abdominal abscess, sepsis, shunt nephritis, focal or generalized peritonitis etc.

Shunt Infection Treatment

Usually, infections of any kind can be very difficult to treat if they are not discovered in time. So, an early diagnosis followed by the adequate treatment option may increase the chances for a full recovery in a short period of time. One of the most challenging infectious disorders is Shunt Infection because its management is still a source of considerable controversies. You are strongly advised to call your health care provider or another health professional as soon as you start experiencing any of the signs and symptoms specific for this type of infection. During the medical examination you will need to speak about the manifestations you accuse and about your personal medical history. In order to rule out other possible and similar medical disorders and to differentiate Shunt Infection from other types of diseases, the health care provider will perform a physical exam followed by several tests. In most cases, establishing the right diagnosis is a major problem.

Identification of the organism that causes the infection is challenging, but also very important because all the treatment options depend a lot on this result. Normally, the immune system releases some specific agents that fight against the harmful microorganisms. Sometimes, bacteria may be difficult to isolate, but the initial count of CSF from the infection site may reveal high numbers of eosinophils and neutrophils. Blood tests are very common diagnosing procedures as they usual reveal elevated amounts of proteins or eosinophilia. If the patient suffers from Shunt Infection, the CSF grain or culture will be positive. The therapies depend on the age of the patient. In small children (who have less than a year of age), the Shunt Infection is more virulent and has higher rates of mortality and morbidity because it is more difficult to manage. The main aims of any treatment for this type of infection are to relieve the symptoms and to eliminate the organisms that caused the infection.

The first choice of treatment is based on antibiotics that are usually administrated for 5 to 15 days, but the duration of the therapy trial may vary. After the revision of the Shunt Infection, IV (intravenous) antibiotics may be continued for the same period of time. If the organism is not detected, the health care providers will apply an empiric (parenteral) therapy based on Vancomycin in combination with Ceftazidime or with Cefepime. Vancomycin is administrated into the vein (IV) – 20 mg/kg, twice a day. The necessary dose of Ceftazidime is 2 g IV three times a day, while the same dose of Cefapime is given twice a day IV. If some patients are allergic to PCN, they will receive 400 mg of Ciprofloxacin, three times a day. If the organism is known, antimicrobials are prescribed to guide therapy. In this case, Vancomycin is administrated in combination with Rifampin (if the cause is represented by coagulase-negative staphylococci). If S. aureus is involved, the patient will receive Nafcillin or Oxacillin in combination with Rifampin. For other organisms, health care providers prefer one or more of the following: Meropenem, Ampicillin, Amphotericin B etc.