Management of Shunt Infections in Children with Hydrocephalus:
Diagnostic Role of Serum and Cerebrospinal Fluid Levels
of C-Reactive Protein
Shunt infection is a common complication in patients with shunt-dependent hydrocephalus. U.S. hospitals traditionally use the patient’s history, clinical findings and cerebrospinal fluid (CSF) measurements to diagnose such infections. However, these tools only accurately diagnose 40% of all shunt infections. Our C-reactive protein (CRP) study sought to investigate if CRP, an acute inflammatory protein which is used in Europe as a shunt infection marker, is a superior diagnostic tool. Although CRP is a non-specific inflammatory protein, it can be used diagnostically once other infections and inflammatory diseases are ruled out.

Our study consisted of 84 children with hydrocephalus and suspected shunt infections and 38 age-matched non-hydrocephalic patients. Blood (serum) and CSF CRP levels were measured. According to routine CSF cultures, 35/84 patients had infections and their serum CRP levels were 91.8 ± SD 70.2 mg/L, with only 1 patient having normal levels (see figure below). The remaining 49/84 patients did not have a shunt infection and their serum CRP levels were 16.1 ± SD 28.3 mg/L, 8 of which had elevated CRP levels (³7 mg/L) but were found to have non-shunt related infections at the time. The CSF CRP levels in this study were not found to be statistically significant. Serum CRP measurement is quicker and less likely to introduce an infection than CSF culture and is more reliable than other currently used parameters.
This study was led by Martin Schuhmann, MD, PhD, whose presentation at the annual meeting of the American Association of Neurological Surgeons Section on Pediatric Neurosurgery in Salt Lake City, UT, December 2-5, 2003 won the prestigious Hydrocephalus Award by the Hydrocephalus Association. In addition, Kimberly Ostrowski, a former Masters Degree student at Wayne State University and current medical student at Michigan State University who assisted in this study, was also awarded the prize for the best neuroscience presentation at the Eastern Student Research Forum in Miami, Fl, February 25-28, 2004. Both of these investigators were supported by STARS, our generous parent and patient support group. The results will be published in September, 2005 in the Journal of Neurosurgery - Pediatrics, and form the basis for a multi-center study with Primary Children's Hospital (Salt Lake City, UT) and the Hospital for Sick Children (Toronto, Canada).