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Central Nervous System Infections Caused by Mycobacterium abscessus

Ventricular Shunt Infection in Two Pediatric Patients and Literature Review

Lamb, Gabriella S., MD*; Del Valle Mojica, Coralee, MD, MPH; Srinivas, Nivedita, MD; Starke, Jeffrey, MD*

The Pediatric Infectious Disease Journal: May 2019 - Volume 38 - Issue 5 - p e99–e104
doi: 10.1097/INF.0000000000002146
Instructive Cases

Abstract: A 4-year-old former 24-week gestation male and an 18-month-old former 26-week gestation female, both with history of intraventricular hemorrhage resulting in hydrocephalus, presented with Mycobacterium abscessus ventricular shunt infections affecting both the shunt track and the ventricular fluid. Both children required prolonged combination antimycobacterial therapy; the 4 years old required more than 2 months of triple intravenous antibiotics and intraventricular amikacin to sterilize the cerebrospinal fluid. Each infection came under control only after removal of all foreign material and multiple and extensive adjunctive surgical procedures to excise infected shunt track tissue. Central nervous system infections caused by M. abscessus are rare, and their management is challenging: prolonged antimicrobial therapy is required, adverse effects from antibiotics are common and rates of mortality and morbidity are high.

From the *Department of Pediatrics, Division of Pediatric Infectious Diseases, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas

Department of Pediatrics, Division of Pediatric Infectious Diseases, Lucile Packard Children’s Hospital, Stanford, California.

Accepted for publication July 7, 2018.

G.S.L. and C.D.V.M. are cofirst authors.

J.S. is on a data safety monitoring board for Otsuka Pharmaceuticals for the pediatric studies of delamanid. The other authors have no conflicts of interest to disclose.

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Address for correspondence: Jeffrey Starke, MD, Texas Children’s Hospital, MC 3-2371, 1102 Bates Avenue, Suite 1150, Houston, TX 77030. E-mail:

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