Chiou C C, Wong T T, Lin H H, Hwang B, Tang R B, Wu K G, Lee B H
Department of Pediatrics, Veterans General Hospital-Taipei, Taiwan.
Clin Infect Dis. 1994 Dec;19(6):1049-53. doi: 10.1093/clinids/19.6.1049.
Infection is still the most common complication of shunt procedures in children. However, fungal infection is still considered to be rare. We found that fungi accounted for 17% of shunt infections (8 of 48) in a retrospective study. All of the patients were premature babies and had received a ventriculoperitoneal shunt because of hydrocephalus. The clinical manifestations were subtle and insidious. The time of onset of infection ranged from 1 month to 1 year after the insertion of the shunt. Examination of the cerebrospinal fluid of infected patients showed mild pleocytosis with an elevated protein concentration. Candida species (including Candida albicans, Candida parapsilosis, and Candida tropicalis) or Torulopsis glabrata were isolated. In all but one case, shunts were removed and systemic therapy with amphotericin B was administered. Amphotericin B was given intrathecally to two patients, who did not respond to systemic therapy. Treatment with fluconazole failed for one patient. We suggest performing fungal cultures in cases of shunt infection, especially those involving premature infants. Extraventricular drainage, systemic therapy with amphotericin B, and insertion of a new shunt remain the principal components of the treatment regimen for fungal shunt infections in children.
感染仍是儿童分流手术最常见的并发症。然而，真菌感染仍被认为较为罕见。在一项回顾性研究中，我们发现真菌占分流感染的17%（48例中有8例）。所有患者均为早产儿，因脑积水接受了脑室腹腔分流术。临床表现隐匿。感染发病时间在分流置入后1个月至1年之间。对感染患者的脑脊液检查显示有轻度细胞增多，蛋白浓度升高。分离出念珠菌属（包括白色念珠菌、近平滑念珠菌和热带念珠菌）或光滑假丝酵母菌。除1例病例外，所有病例均移除了分流管并给予两性霉素B全身治疗。有2例患者对全身治疗无反应，给予了鞘内注射两性霉素B。1例患者使用氟康唑治疗失败。我们建议在分流感染病例中进行真菌培养，尤其是涉及早产儿的病例。脑室外引流、两性霉素B全身治疗以及置入新的分流管仍是儿童真菌性分流感染治疗方案的主要组成部分。
