It is very difficult to determine the optimal time for shunt re-implantation after cerebrospinal fluid (CSF) shunt infection. Total white blood cell count, neutrophil, eosinophil granulocyte and plasma cell counts in CSF do not always provide adequate information for the right decision to re-implant a shunt after an infection. Re-infections have been frequently observed. We therefore decided to examine the contribution the three cytokines IL-6, IL-12 and IL-13 (CSF) could bring in deciding on shunt re-implantation.
Three patients (2 boys, 1 girl, age: 4 months to 17.5 years) with external CSF drainage and shunt infections due to Staphylococcus epidermidis had their CSF examined by ELISA for IL-6, IL-12, and IL-13 over a period of 3–50 days. A simultaneous examination of the cytograms was done and compared with the cytokine results.
The Table shows the similarity in behaviour of the inflammatory cells (IC) and the patients' CSF cytokines.
Whereas the CSF inflammatory cytokines IL-6 and IL-12 decrease in concentration, the anti-inflammatory cytokine IL-13 concentration increases. This means that the cytokines could be a good indicator for the course of CSF infections and hence an indicator for the optimal timing for shunt re-implantation. CSF leucocyte count and its differentiation depends on the examiner and on the quality of cell preparation. Thus the quantitative determination of the cytokines is more objective. Regrettably, the cytokine values are very variable, meaning that only trends can be estimated. Further studies are needed for reliable information concerning the CSF infection status.