Infective endocarditis as a complication of longstanding ventriculoatrial (VA) shunt: the importance of suspicion and early investigation in patients with VA shunt and pyrexia of unknown origin
Ventriculoatrial (VA) shunts are a method of cerebrospinal fluid diversion, which nowadays are infrequently seen in medical practice. Infective endocarditis (IE) can occur as rare complications of VA shunts, through the introduction of a foreign body close to the tricuspid valve. We report a case of...
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| Veröffentlicht in: | BMJ case reports 2021-01, Vol.14 (1), p.e237161 |
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| creator | Sun, Rosa Warwick, Richard Harrisson, Stuart Bandla, Nageswar |
| description | Ventriculoatrial (VA) shunts are a method of cerebrospinal fluid diversion, which nowadays are infrequently seen in medical practice. Infective endocarditis (IE) can occur as rare complications of VA shunts, through the introduction of a foreign body close to the tricuspid valve. We report a case of infective endocarditis, that is, in a patient with VA shunt for congenital hydrocephalus. We present the case to highlight the importance of early investigation for IE in patients with fever of unknown origin and shunt in situ, as rapid deterioration can occur and be fatal. We also discuss past experience reported in the literature on the role of cardiothoracic intervention. Prompt diagnosis and early cardiothoracic referral for surgery are crucial, there may only be a narrow window of opportunity for intervention before patients develop fulminant sepsis. |
| doi_str_mv | 10.1136/bcr-2020-237161 |
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Infective endocarditis (IE) can occur as rare complications of VA shunts, through the introduction of a foreign body close to the tricuspid valve. We report a case of infective endocarditis, that is, in a patient with VA shunt for congenital hydrocephalus. We present the case to highlight the importance of early investigation for IE in patients with fever of unknown origin and shunt in situ, as rapid deterioration can occur and be fatal. We also discuss past experience reported in the literature on the role of cardiothoracic intervention. Prompt diagnosis and early cardiothoracic referral for surgery are crucial, there may only be a narrow window of opportunity for intervention before patients develop fulminant sepsis.</description><identifier>ISSN: 1757-790X</identifier><identifier>EISSN: 1757-790X</identifier><identifier>DOI: 10.1136/bcr-2020-237161</identifier><identifier>PMID: 33462007</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Antibiotics ; Case Report ; Case reports ; Catheters ; Cerebrospinal Fluid Shunts - adverse effects ; Endocarditis ; Endocarditis, Bacterial - diagnosis ; Endocarditis, Bacterial - etiology ; Fever of Unknown Origin - etiology ; Humans ; Hydrocephalus ; Intensive care ; Male ; Middle Aged ; Nervous system ; Neurosurgery ; Patients ; Postoperative Complications - diagnosis ; Postoperative Complications - etiology ; Sepsis ; Staphylococcal Infections - diagnosis ; Staphylococcal Infections - etiology ; Staphylococcus aureus - isolation & purification ; Staphylococcus infections ; Surgery ; Thrombocytopenia ; Ultrasonic imaging</subject><ispartof>BMJ case reports, 2021-01, Vol.14 (1), p.e237161</ispartof><rights>BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2021 BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ. 2021</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c375t-76439d90f8f92447154baa8c845e7318db3cf2b8dd4ef765815854729ad9d3c53</cites><orcidid>0000-0002-4979-1574</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816911/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816911/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33462007$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sun, Rosa</creatorcontrib><creatorcontrib>Warwick, Richard</creatorcontrib><creatorcontrib>Harrisson, Stuart</creatorcontrib><creatorcontrib>Bandla, Nageswar</creatorcontrib><title>Infective endocarditis as a complication of longstanding ventriculoatrial (VA) shunt: the importance of suspicion and early investigation in patients with VA shunt and pyrexia of unknown origin</title><title>BMJ case reports</title><addtitle>BMJ Case Rep</addtitle><description>Ventriculoatrial (VA) shunts are a method of cerebrospinal fluid diversion, which nowadays are infrequently seen in medical practice. Infective endocarditis (IE) can occur as rare complications of VA shunts, through the introduction of a foreign body close to the tricuspid valve. We report a case of infective endocarditis, that is, in a patient with VA shunt for congenital hydrocephalus. We present the case to highlight the importance of early investigation for IE in patients with fever of unknown origin and shunt in situ, as rapid deterioration can occur and be fatal. We also discuss past experience reported in the literature on the role of cardiothoracic intervention. Prompt diagnosis and early cardiothoracic referral for surgery are crucial, there may only be a narrow window of opportunity for intervention before patients develop fulminant sepsis.</description><subject>Antibiotics</subject><subject>Case Report</subject><subject>Case reports</subject><subject>Catheters</subject><subject>Cerebrospinal Fluid Shunts - adverse effects</subject><subject>Endocarditis</subject><subject>Endocarditis, Bacterial - diagnosis</subject><subject>Endocarditis, Bacterial - etiology</subject><subject>Fever of Unknown Origin - etiology</subject><subject>Humans</subject><subject>Hydrocephalus</subject><subject>Intensive care</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Nervous system</subject><subject>Neurosurgery</subject><subject>Patients</subject><subject>Postoperative Complications - diagnosis</subject><subject>Postoperative Complications - etiology</subject><subject>Sepsis</subject><subject>Staphylococcal Infections - diagnosis</subject><subject>Staphylococcal Infections - etiology</subject><subject>Staphylococcus aureus - isolation & purification</subject><subject>Staphylococcus infections</subject><subject>Surgery</subject><subject>Thrombocytopenia</subject><subject>Ultrasonic imaging</subject><issn>1757-790X</issn><issn>1757-790X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNpdUk1v1DAUtBCIVkvP3JAlLu0hNP5I7HBAWlVQKlXiAhU3y7GdrEtiB9vZsj-Pf1aHlKpgWfKTPDPvjd4A8BqV7xAi9XmrQoFLXBaYMFSjZ-AYsYoVrCm_P39SH4GTGG_LfAiinJKX4IgQWuOyZMfg95XrjEp2b6Bx2isZtE02QpkvVH6cBqtkst5B38HBuz4m6bR1Pdwbl4JV8-BlfuUAT2-2ZzDuZpfew7Qz0I6TDxmtzMKNc5ysWoQyHxoZhgO0bm9isv3awDo45SrLRnhn0w7ebFe5P4zpEMwvKxep2f1w_i5PFGxv3SvwopNDNCcP7wZ8-_Tx68Xn4vrL5dXF9rpQhFWpYDUljW7KjncNppShirZScsVpZRhBXLdEdbjlWlPTsbriqOIVZbiRutFEVWQDPqy609yORqvFvhzEFOwow0F4acW_P87uRO_3gnFUN3lhG3D6IBD8zzkbF6ONygyDdMbPUWCat0U4bpZeb_-D3vo5uGxP4AphhlmDWUadrygVfIzBdI_DoFIsCRE5IWJJiFgTkhlvnnp4xP_NA7kHOF-8Sw</recordid><startdate>20210118</startdate><enddate>20210118</enddate><creator>Sun, Rosa</creator><creator>Warwick, Richard</creator><creator>Harrisson, Stuart</creator><creator>Bandla, Nageswar</creator><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-4979-1574</orcidid></search><sort><creationdate>20210118</creationdate><title>Infective endocarditis as a complication of longstanding ventriculoatrial (VA) shunt: the importance of suspicion and early investigation in patients with VA shunt and pyrexia of unknown origin</title><author>Sun, Rosa ; Warwick, Richard ; Harrisson, Stuart ; Bandla, Nageswar</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-76439d90f8f92447154baa8c845e7318db3cf2b8dd4ef765815854729ad9d3c53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Antibiotics</topic><topic>Case Report</topic><topic>Case reports</topic><topic>Catheters</topic><topic>Cerebrospinal Fluid Shunts - adverse effects</topic><topic>Endocarditis</topic><topic>Endocarditis, Bacterial - diagnosis</topic><topic>Endocarditis, Bacterial - etiology</topic><topic>Fever of Unknown Origin - etiology</topic><topic>Humans</topic><topic>Hydrocephalus</topic><topic>Intensive care</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Nervous system</topic><topic>Neurosurgery</topic><topic>Patients</topic><topic>Postoperative Complications - diagnosis</topic><topic>Postoperative Complications - etiology</topic><topic>Sepsis</topic><topic>Staphylococcal Infections - diagnosis</topic><topic>Staphylococcal Infections - etiology</topic><topic>Staphylococcus aureus - isolation & purification</topic><topic>Staphylococcus infections</topic><topic>Surgery</topic><topic>Thrombocytopenia</topic><topic>Ultrasonic imaging</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sun, Rosa</creatorcontrib><creatorcontrib>Warwick, Richard</creatorcontrib><creatorcontrib>Harrisson, Stuart</creatorcontrib><creatorcontrib>Bandla, Nageswar</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ case reports</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sun, Rosa</au><au>Warwick, Richard</au><au>Harrisson, Stuart</au><au>Bandla, Nageswar</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Infective endocarditis as a complication of longstanding ventriculoatrial (VA) shunt: the importance of suspicion and early investigation in patients with VA shunt and pyrexia of unknown origin</atitle><jtitle>BMJ case reports</jtitle><addtitle>BMJ Case Rep</addtitle><date>2021-01-18</date><risdate>2021</risdate><volume>14</volume><issue>1</issue><spage>e237161</spage><pages>e237161-</pages><issn>1757-790X</issn><eissn>1757-790X</eissn><abstract>Ventriculoatrial (VA) shunts are a method of cerebrospinal fluid diversion, which nowadays are infrequently seen in medical practice. Infective endocarditis (IE) can occur as rare complications of VA shunts, through the introduction of a foreign body close to the tricuspid valve. We report a case of infective endocarditis, that is, in a patient with VA shunt for congenital hydrocephalus. We present the case to highlight the importance of early investigation for IE in patients with fever of unknown origin and shunt in situ, as rapid deterioration can occur and be fatal. We also discuss past experience reported in the literature on the role of cardiothoracic intervention. Prompt diagnosis and early cardiothoracic referral for surgery are crucial, there may only be a narrow window of opportunity for intervention before patients develop fulminant sepsis.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>33462007</pmid><doi>10.1136/bcr-2020-237161</doi><orcidid>https://orcid.org/0000-0002-4979-1574</orcidid><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central |
| subjects | Antibiotics Case Report Case reports Catheters Cerebrospinal Fluid Shunts - adverse effects Endocarditis Endocarditis, Bacterial - diagnosis Endocarditis, Bacterial - etiology Fever of Unknown Origin - etiology Humans Hydrocephalus Intensive care Male Middle Aged Nervous system Neurosurgery Patients Postoperative Complications - diagnosis Postoperative Complications - etiology Sepsis Staphylococcal Infections - diagnosis Staphylococcal Infections - etiology Staphylococcus aureus - isolation & purification Staphylococcus infections Surgery Thrombocytopenia Ultrasonic imaging |
| title | Infective endocarditis as a complication of longstanding ventriculoatrial (VA) shunt: the importance of suspicion and early investigation in patients with VA shunt and pyrexia of unknown origin |
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