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You are seeing a 3 year old ex-premature infant who has a ventriculoperitoneal shunt in place. The patient presents with fever to 38.3, cough, and runny nose. There is no headache, vomiting, or altered mental status. The shunt was placed initially while in the NICU, and revised 4 months ago.
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July 26, 2021 at 2:39 am
E) Shunt infection can present as peritonitis (fever, abdominal pain, anorexia)
The incidence of shunt infection is 5-12%. While shunt infection is most common in the first month after placement or revision, 60% occur within 2 months and 90% within 6 months of placement. Shunt tap for diagnosis is controversial; lumbar puncture is often preferred due to ED practitioner familiarity with the procedure and lower risk of actually introducing infection. Coagulase-negative staph (Staphylococcus epidermidis) accounts for half of shunt infections, while Staphylococcus aureus accounts for only 30%. Shunt infection can present as peritonitis, particularly with associated peritoneal cyst of bowel perforation.