Intra-Abdominal Ventriculoperitoneal Shunt Abscess from Streptococcus Pyogenes after Pharyngitis with Scarlet Fever: Case Report and Review of the Literature
Ventriculoperitoneal shunt (VPS) infections are frequent complications that result in
shunt failure in 5-15% of patients.
Common causative agents include Staphylococcus aureus,
Coagulase-negative staphylococcus species, a variety of gram-negative rods, Propionibacterium species, and Enterococcus faecalis.
Other less common isolates include Haemophilus influenza type B, Klebsiella pneumoniae, Serratia marcescens, Group B Streptococcus, Streptococcus pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa and Morganella morganii.
The mechanism of shunt infection most frequently involves colonization of the shunt by skin
flora at the time of surgery or postoperatively via breakdown of the wound. Alternatively, shunt
infection can occur due to direct contamination of the peritoneal end of the shunt by gut flora
in the setting of bowel perforation or peritonitis.
We present a rare case of a hydrocephalic patient with a ventriculoperitoneal shunt
who developed a Streptococcus pyogenes (Group A Streptococcus, GAS) peritoneal catheter associated intra-abdominal abscess that occurred several weeks after pharyngitis and scarlet fever.
GAS colonizes epithelial surfaces, primarily the throat and skin, but also the vagina and
rectum, from where it can cause a wide array of superficial, invasive, and immune-mediated
diseases. GAS most commonly causes mild infections such as pharyngitis and impetigo, but is also associated with serious non-suppurative complications
such as acute rheumatic fever, acute glomerulonephritis, and toxic shock syndrome.
Neuro Open J. 2014; 1(1): 27-30. doi: 10.17140/NOJ-1-107
