Fungal Infections of Cerebrospinal Fluid Shunt in Pediatric Patients: A Systematic Literature Review With a Case Report.

Abstract

The standard treatment of hydrocephalus consists of the implantation of a cerebrospinal fluid (CSF) shunt. Infection of the CSF shunts affects 5%-15% of the patients, primarily due to bacterial pathogens, with rare cases involving fungi. This study aimed to systematically review the clinical characteristics, diagnostic approaches, treatment strategies, and outcomes of fungal CSF shunt infections in children. A systematic review was conducted according to the PRISMA guidelines. PubMed, Scopus, Web of Science, Mendeley, and Cochrane Library databases were searched for studies on fungal CSF shunt infection in children, published from inception until 6 September 2024. A total of 26 studies reporting on 38 pediatric patients were found eligible, including our institutional case; a total of 39 patients were analyzed. Candida genus remained the most common causative agent (76.92%), with Candida albicans being the most prevalent (58.97%). CSF culture confirmed the infection in 77.78% of the cases. Amphotericin B was the most frequently used antifungal agent in monotherapy (55.56%). The primary route of administration was intravenous (92.86%), while intraventricular and intrathecal administration were used in 27.59%, and 20.00% of patients, respectively. Notably, 5.13% patients underwent fungal vegetation removal. Both the recurrence and the mortality rates were 10.81%. Fungal CSF shunt infections pose significant therapeutic challenges, necessitating the implementation of a broad treatment strategy to achieve successful outcomes. Intraventricular and intrathecal antifungal drug administration may become necessary, especially in persistent fungal infections.