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Brain abscess in relation to infection of the ventriculoperitoneal shunt system
Absceso cerebral secundario a infección del sistema de derivación ventrículo-peritoneal
S.M. Santos-Seoane
, R. Cabo-Madagán, A. Rodriguez-Guardado
Corresponding author
Servicio de Medicina Interna, Hospital de Cabueñes, Gijón, Asturias, Spain
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Santos-Seoane, R. Cabo-Madagán, A. Rodriguez-Guardado" "autores" => array:3 [ 0 => array:4 [ "nombre" => "S.M." "apellidos" => "Santos-Seoane" "email" => array:1 [ 0 => "smsspulp@yahoo.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "R." "apellidos" => "Cabo-Madagán" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Rodriguez-Guardado" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Medicina Interna, Hospital de Cabueñes, Gijón, Asturias, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Absceso cerebral secundario a infección del sistema de derivación ventrículo-peritoneal" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:6 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 605 "Ancho" => 570 "Tamanyo" => 41330 ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 73-year-old man with a ventriculoperitoneal shunt implanted 4 months earlier due to normal pressure hydrocephalus was admitted for a fever of 39.6<span class="elsevierStyleHsp" style=""></span>°<span class="elsevierStyleSmallCaps">C</span> that started 48<span class="elsevierStyleHsp" style=""></span>h earlier and presented generalized tonic–clonic seizures on the day of admission. Cranial computed tomography showed a hypodense space-occupying lesion in the white matter of the right frontal lobe, measuring 43<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>34<span class="elsevierStyleHsp" style=""></span>mm, with peripheral contrast uptake, located on the shunt (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), with associated perilesional vasogenic edema and compression of the right lateral ventricle, with no midline deviation (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). We drained the abscess and withdrew the entire device. The various cultures were positive for methicillin-resistant <span class="elsevierStyleItalic">Staphylococcus aureus</span>.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">A cerebrospinal fluid shunt is one of the most common neurosurgical procedures and can be external (temporary) or internal. Infections occur in 5–15% of these procedures, representing 45–52% of cases of nosocomial meningitis/ventriculitis in adults, with most infections appearing in the first month after placement. The associated factors are patient-related (extreme age, main process, comorbidities, skin lesions), surgery-related (duration, neurosurgeon's experience) and shunt-related (previous neurosurgery, checks, previous shunt infection). The biomaterial's properties, the host's defense mechanisms and bacterial virulence factors also play a role. Infections occur after the colonization of the shunt with skin flora during surgery or by skin lesions adjacent to the shunt. Infections can also occur through hematogenous pathways and by retrograde infection from the catheter.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The predominant agents are staphylococci, with Gram-negative bacilli isolated in devices that drain the cerebrospinal fluid to the peritoneal cavity. Treatment includes withdrawing the entire system, as well as antibiotherapy.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-06-03" "fechaAceptado" => "2018-06-25" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Santos-Seoane SM, Cabo-Madagán R, Rodriguez-Guardado A. Absceso cerebral secundario a infección del sistema de derivación ventrículo-peritoneal. 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