{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T23:23:52Z","timestamp":1793402632724,"version":"4.5.0"},"reference-count":43,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["PED"],"published-print":{"date-parts":[[2008,4]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Eosinophils have been reported in children with cerebrospinal fluid (CSF) shunts. The goal of this study was to describe the risk factors, relationship to infection, and clinical significance of CSF eosinophilia in a large group of shunt-treated patients.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The authors performed a retrospective review of data obtained in all patients who underwent ventricular shunt placement or revision at the James Whitcomb Riley Hospital for Children between 2000 and 2004.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Eosinophils were identified during a follow-up shunt evaluation in 93 (31%) of 300 patients after initial shunt placement. Eosinophilia was statistically related to CSF extravasation (p &lt; 0.0001), shunt infection (p = 0.031), blood in CSF (p &lt; 0.0001), younger age at shunt insertion (p = 0.030), and the diagnosis of posthemorrhagic hydrocephalus (p &lt; 0.0001). Patients with CSF eosinophilia had a higher risk of subsequent shunt failure (p &lt; 0.0001).<\/jats:p>\n<jats:p>Analysis was performed using data obtained in a cohort of patients with a total of 130 shunt infections. Cerebrospinal fluid eosinophils were identified in 118 infections (90.8%). The leukocytic and eosinophilic reactions were dependent on the infecting organism. <jats:italic>Propionibacterium acnes<\/jats:italic> had a statistically lower CSF leukocyte count but higher differential percentage of eosinophils than the other common pathogens.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Cerebrospinal fluid eosinophilia is a relatively common finding in children with shunts. Patients with CSF eosinophilia had an increased risk of shunt malfunction in the present series. Eosinophilia is associated with infection, CSF extravasation, and blood in the CSF. Patients with <jats:italic>P. acnes<\/jats:italic>\u2013induced shunt infections have higher eosinophil percentages than are found in infections associated with other common organisms. Therefore, in patients with eosinophilia, extended anaerobic culture studies should be performed with particular attention paid to searching for this pathogen.<\/jats:p><\/jats:sec>","DOI":"10.3171\/ped\/2008\/1\/4\/288","type":"journal-article","created":{"date-parts":[[2008,3,31]],"date-time":"2008-03-31T18:11:23Z","timestamp":1206987083000},"page":"288-295","source":"Crossref","is-referenced-by-count":18,"title":["Cerebrospinal fluid eosinophilia in children with ventricular shunts"],"prefix":"10.3171","volume":"1","author":[{"given":"Daniel H.","family":"Fulkerson","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel C.","family":"Boaz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-0010288","series-title":"Pediatr Neurosurg","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1159\/000028874","article-title":"Late shunt infections","volume":"31","author":"Baird","year":"1999"},{"key":"b2-0010288","series-title":"Am J Med","doi-asserted-by":"publisher","first-page":"935","DOI":"10.1016\/0002-9343(76)90418-6","article-title":"Propionibacterium acnes: pathogen in central nervous shunt infection. Report of three cases including immune complex glomerulonephritis","volume":"61","author":"Beeler","year":"1976"},{"key":"b3-0010288","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/BF01411427","article-title":"Risk of infection after cerebrospinal fluid shunt: an analysis of 884 first-time shunts","volume":"136","author":"Borgbjerg","year":"1995"},{"key":"b4-0010288","series-title":"J Neurol","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1007\/BF00314392","article-title":"Eosinophilic granulocytes in cerebro-spinal fluid: analysis of 94 cerebrospinal fluid specimens and review of the literature","volume":"219","author":"Bosch","year":"1978"},{"key":"b5-0010288","series-title":"Br J Haematol","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1046\/j.1365-2141.2003.04195.x","article-title":"The eosinophilias, including idiopathic hypereosinophilic syndrome","volume":"121","author":"Brito-Babapulle","year":"2003"},{"key":"b6-0010288","series-title":"Youmans Neurological Surgery","first-page":"3419","article-title":"Shunt infection","volume":"Vol 3","author":"Claus","year":"2004"},{"key":"b7-0010288","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1007\/BF00300722","article-title":"Cerebrospinal fluid shunt infections in infants","volume":"11","author":"Dallacasa","year":"1995"},{"key":"b8-0010288","series-title":"Pediatr Neurosurg","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1159\/000028806","article-title":"Does age or other factors influence the incidence of ventriculoperitoneal shunt infections?","volume":"30","author":"Davis","year":"1999"},{"key":"b9-0010288","series-title":"Cancer","doi-asserted-by":"publisher","first-page":"330","DOI":"10.1002\/1097-0142(19830715)52:2<330::AID-CNCR2820520224>3.0.CO;2-T","article-title":"Propio-nibacterium shunt nephritis in two adolescents with medulloblastoma","volume":"52","author":"Frank","year":"1983"},{"key":"b10-0010288","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1079","DOI":"10.3171\/jns.1984.61.6.1079","article-title":"Sterile shunt malfunction. A scanning electron microscopic perspective","volume":"61","author":"Gower","year":"1984"},{"key":"b11-0010288","series-title":"Neurosurgery","first-page":"630","article-title":"Intraventricular vancomycin-induced cerebrospinal fluid eosinophilia: report of two patients","volume":"30","author":"Grabb","year":"1992"},{"key":"b12-0010288","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1007\/BF00313586","article-title":"Silicone allergy in ventriculoperitoneal shunts","volume":"10","author":"Jimenez","year":"1994"},{"key":"b13-0010288","series-title":"Pediatric Neurosurgery: Surgery of the Developing Nervous System","first-page":"529","article-title":"Management of the complications of shunting","author":"Kaufman","year":"2001"},{"key":"b14-0010288","series-title":"Dev Med Child Neurol","first-page":"378","article-title":"Eosinophilia of the cerebrospinal fluid: late reaction to a silastic shunt","volume":"30","author":"Kennedy","year":"1988"},{"key":"b15-0010288","series-title":"Neurology","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1212\/WNL.9.5.371","article-title":"Eosinophilia of the cerebrospinal fluid of noninfectious origin: report of 2 cases","volume":"9","author":"Kessler","year":"1959"},{"key":"b16-0010288","series-title":"Infection","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1007\/BF01710738","article-title":"CSF shunt infections in children","volume":"21","author":"Kontny","year":"1993"},{"issue":"A1 Suppl","key":"b17-0010288","series-title":"J Biomed Mater Res","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1002\/jbm.820231308","article-title":"Clinical-pathological analysis of failed central nervous system fluid shunts","volume":"23","author":"Kossovsky","year":"1989"},{"key":"b18-0010288","series-title":"Ann Intern Med","doi-asserted-by":"publisher","first-page":"70","DOI":"10.7326\/0003-4819-91-1-70","article-title":"Eosinophils in the cerebrospinal fluid","volume":"91","author":"Kuberski","year":"1979"},{"key":"b19-0010288","series-title":"Am J Med","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1016\/S0002-9343(02)01495-X","article-title":"Eosinophilic meningitis","volume":"114","author":"Lo Re","year":"2003"},{"key":"b20-0010288","series-title":"J Clin Microbiol","doi-asserted-by":"publisher","first-page":"3109","DOI":"10.1128\/jcm.35.12.3109-3111.1997","article-title":"Clinical utility of broth cultures of cerebrospinal fluid from patients at risk for shunt infection","volume":"35","author":"Meredith","year":"1997"},{"key":"b21-0010288","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1227\/00006123-198611000-00022","article-title":"Eosinophilia of the cerebrospinal fluid in a case of shunt infection: case report","volume":"19","author":"Mine","year":"1986"},{"key":"b22-0010288","series-title":"Allergy","doi-asserted-by":"publisher","first-page":"268","DOI":"10.1111\/j.1398-9995.2003.00442.x","article-title":"Eosinophils: \u201cnew\u201d roles for \u201cold\u201d cells","volume":"59","author":"Munitz","year":"2004"},{"key":"b23-0010288","series-title":"J Allergy Clin Immunol","doi-asserted-by":"publisher","first-page":"849","DOI":"10.1016\/S0091-6749(97)70284-7","article-title":"Latex allergy as a cause of eosinophilia in cerebrospinal fluid in a child with ventricular shunt","volume":"100","author":"Niggemann","year":"1997"},{"key":"b24-0010288","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"328","DOI":"10.3171\/jns.1984.61.2.0328","article-title":"Shunt fluid examination: risks and benefits in the evaluation of shunt malfunction and infection","volume":"61","author":"Noetzel","year":"1984"},{"key":"b25-0010288","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"553","DOI":"10.3171\/jns.1980.52.4.0553","article-title":"Diphtheroid infections of cerebrospinal fluid shunts. The changing pattern of shunt infection in Cleveland","volume":"52","author":"Rekate","year":"1980"},{"key":"b26-0010288","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"1592","DOI":"10.1056\/NEJM199805283382206","article-title":"Eosinophilia","volume":"338","author":"Rothenberg","year":"1998"},{"key":"b27-0010288","series-title":"Annu Rev Immunol","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1146\/annurev.immunol.24.021605.090720","article-title":"The eosinophil","volume":"24","author":"Rothenberg","year":"2006"},{"key":"b28-0010288","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"411","DOI":"10.3171\/jns.1982.56.3.0411","article-title":"Malfunctioning ventriculoperitoneal shunts. Clinical and pathological features","volume":"56","author":"Sekhar","year":"1982"},{"key":"b29-0010288","series-title":"Allergy","doi-asserted-by":"publisher","first-page":"561","DOI":"10.1111\/j.1398-9995.2004.00476.x","article-title":"Eosinophils and atopic dermatitis","volume":"59","author":"Simon","year":"2004"},{"key":"b30-0010288","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1016\/0090-3019(89)90119-5","article-title":"Hypersensitivity reaction associated with sterile ventriculoperitoneal shunt malfunction","volume":"31","author":"Snow","year":"1989"},{"key":"b31-0010288","series-title":"Neurosurgery","first-page":"858","article-title":"Ventriculoperitoneal shunt infections with gram-negative bacteria","volume":"33","author":"Stamos","year":"1993"},{"key":"b32-0010288","series-title":"Pediatr Neurosurg","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1159\/000028752","article-title":"A case of cerebrospinal fluid eosinophilia associated with shunt malfunction","volume":"30","author":"Tanaka","year":"1999"},{"key":"b33-0010288","series-title":"Ann Allergy Asthma Immunol","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1016\/S1081-1206(10)62675-0","article-title":"Glucocorticosteroid treatment for cerebrospinal fluid eosinophilia in a patient with ventriculoperitoneal shunt","volume":"83","author":"Tangsinmankong","year":"1999"},{"key":"b34-0010288","series-title":"Br J Haematol","doi-asserted-by":"publisher","first-page":"468","DOI":"10.1111\/j.1365-2141.2006.06038.x","article-title":"Eosinophilia: secondary, clonal and idiopathic","volume":"133","author":"Tefferi","year":"2006"},{"key":"b35-0010288","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1007\/s003810050248","article-title":"Propionibacterium acnes infections of cerebrospinal fluid shunt","volume":"14","author":"Thompson","year":"1998"},{"key":"b36-0010288","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1227\/00006123-198811000-00019","article-title":"Cerebrospinal fluid eosinophilia and sterile shunt malfunction","volume":"23","author":"Traynelis","year":"1988"},{"key":"b37-0010288","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"541","DOI":"10.3171\/jns.1991.75.4.0541","article-title":"Ventricular cerebrospinal fluid eosinophilia in children with ventriculoperitoneal shunts","volume":"75","author":"Tung","year":"1991"},{"key":"b38-0010288","series-title":"Acta Cytol","first-page":"277","article-title":"Eosinophilia in the cerebrospinal fluid of children with shunts implanted for the treatment of internal hydrocephalus","volume":"30","author":"Tzvetanova","year":"1986"},{"key":"b39-0010288","series-title":"Childs Nerv Syst","doi-asserted-by":"publisher","first-page":"692","DOI":"10.1007\/s00381-005-0037-8","article-title":"Cerebrospinal fluid shunt infection: risk factors and long-term follow-up","volume":"22","author":"Vinchon","year":"2006"},{"key":"b40-0010288","series-title":"Neuropediatrics","doi-asserted-by":"publisher","first-page":"235","DOI":"10.1055\/s-2008-1071349","article-title":"Cerebrospinal fluid eosinophilia in shunt infections","volume":"23","author":"Vinchon","year":"1992"},{"key":"b41-0010288","series-title":"Clin Pediatr (Phila)","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1177\/000992280404300413","article-title":"Late-onset central nervous system shunt infections with Propionibacterium acnes: diagnosis and management","volume":"43","author":"Viraraghavan","year":"2004"},{"key":"b42-0010288","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1007\/BF01850865","article-title":"Propionebacterium acnes in cultures from ventriculo-peritoneal shunts: infection of contamination?","volume":"139","author":"Westergren","year":"1997"},{"key":"b43-0010288","series-title":"Acta Neurol Scand","first-page":"201","article-title":"The diagnostic importance of eosinophil granulocytes in the CSF of children with ventricular-peritoneal shunt systems","volume":"97","author":"Wiersbitzky","year":"1998"}],"container-title":["Journal of Neurosurgery: Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/1\/4\/article-p288.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/1\/4\/article-p288.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-pediatr\/1\/4\/article-p288.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,15]],"date-time":"2023-04-15T14:47:31Z","timestamp":1681570051000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-pediatr\/1\/4\/article-p288.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2008,4]]},"references-count":43,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/ped\/2008\/1\/4\/288","relation":{},"ISSN":["1933-0707","1933-0715"],"issn-type":[{"value":"1933-0707","type":"print"},{"value":"1933-0715","type":"electronic"}],"subject":[],"published":{"date-parts":[[2008,4]]}}}