Article Text

PDF
Fever in a child with cerebrospinal fluid access device or shunt: a pragmatic approach to management
  1. Betsy Cleave1,
  2. Maria Cartmill2,
  3. Shiu Shing Soo3,
  4. Harish Vyas1
  1. 1PICU and Respiratory Medicine, Nottingham University Hospital, Nottingham, UK
  2. 2Department of Neurosurgery, Nottingham University Hospital, Nottingham, UK
  3. 3Department of Microbiology, Nottingham University Hospital, Nottingham, UK
  1. Correspondence to Professor Harish Vyas, C/O PICU/Respiratory Medicine, Nottingham University Hospitals, Nottingham NG72UH, UK; harish.vyas{at}nuh.nhs.uk

Abstract

Children with shunts commonly present with fever, and often the focus of infection will be unrelated to their shunt. However, as shunt infections may present with few or even no specific symptoms, evaluation of a child with a shunt presenting with fever should be careful and comprehensive to ensure shunt infections are not missed. Treatment of an infected shunt involves removal of the shunt followed by a long course of antibiotics; missing or partially treating shunt infections can result in significant morbidity and potentially even mortality. Our experience of managing children with shunts presenting with fever is that many non-specialist clinicians have little experience in this area so initial management may not always be appropriate. Those children who are most at risk of shunt infection are those who within the preceding 8 weeks have had insertion, revision or access of their shunt or chemotherapy device, or have had abdominal surgery in the presence of a ventriculoperitoneal shunt. We have chosen 8 weeks as a pragmatic time point, as in our experience the vast majority of children who have had shunt infections have presented within this period. The caveat is that this should not be used as an absolute cut-off where there is strong suspicion of shunt infection or no clear focus at a later time point.

  • Infectious Diseases
  • Neurosurgery
  • Microbiology

Statistics from Altmetric.com

Footnotes

  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.