What Do These Following CSF Culture And Sensitivity Test Results Indicate?

Posted on Tue, 17 Jan 2017

Question: My one month old son has undergone an ETV surgery few days back and doctors suggested CSF culture and sensitivity test. The reports suggest occasional pus cells with few negative rods seen. Also the reports suggest culture shows growth of citrobacter freundii. Could you help me in this issue with your suggestions.

Answered by Dr. Dr. Pradeep Kumar Jain (52 minutes later)

Brief Answer:
CSF report auggests infection and antibiotic treatment is needed

Detailed Answer:
Hello

Thanks for asking on this platform

I have gone through the details.Endoscopic third ventriculostomy is a modlaity of treatment for management of hydrocephalus.
Hydrocephalus at one month of age is mostly due to congenital obstruction of ventricular system but may also be due to some infection(meningitis).
CSF report as you have mentioned suggests infection with Citrobactor.
I would like to know the cause of hydrocephalus as this will give a clue whether the infection is the cause of hydrocephalus or it has developed later on.
Intravenous antibiotic treatment is needed in this condition as per the sensitivity report)to which the bacteria is most sensitive).
In most of the cases outcome is very good after proper treatment.

I hope this helps.
Please let me know if you have any more queries.
Regards

Above answer was peer-reviewed by : Dr. Nagamani Ng

Follow up: Dr. Dr. Pradeep Kumar Jain (3 hours later)

Thanks for your valuable time and feedback.

I have attached the post operative report of the ETV surgery of my son. The hydrocephalus that doctors identified was non infectious and was just congenital. There were no such symptoms identified, apart from increase in head circumference. The doctors also identified Dandy Walker malformation in initial reports however as per their discussion they denied the fact and suggested that the case is not that complicated.

I would also like to inquire that what are the prognosis of the hydrocephalus in my son. The doctors have also suggested the waiting period of 1-2 months where they have asked us to regularly measure the head circumference of my son that it does not increase. The draining of fluid from his head has created a shallow in his head which is also quite deep (doctors sounding it positive as if the shallow is quite deep then it is a good sign of surgery). I would like to know your opinion on this.

For your reference I have attached the post operative report (discharge summary) which provides all the details in the same.

Answered by Dr. Dr. Pradeep Kumar Jain (2 hours later)

Brief Answer:
Long term follow up with neurological assessment is needed

Detailed Answer:
Thanks for follow up

I have read the discharge summary.You are right as it is clearly mentioned that it was non infective.
I assume that all routine investigations for diagnosis of hydrocephalus like MRI,blood test to rule out congenital infection must have been done.
ETV is a very good modality for management of congenital hydrocephalus.
As there is no neurological deficit in your baby and brain grows till age of 2 years,the prognosis is good in such cases.
A long term follow up at regular interval is needed to see the neurological outcome.
These children are at risk of mental/behavioral abnormality,vision/hearing difficulty, poor body growth and epilepsy in future.These risks vary in different individual and can be detected only during follow up.
I agree with your doctor as depression in skull (depressed fontanelle)is a good sign after ETV and indicates that the surgery is successful.
I suggest you to keep the baby in regular follow up of your doctor .
Wishing for your child's good health.
Regards

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar