Letters to the Editor
343
References I. Bhatti N, Larson E, Hickey M, Seal D. Encephalitis due to Epstein-Barr virus. J Infect 199o; 20 : 69-72. 2. Sanyal D, Kudesia G, Young M. Epstein-Barr virus encephalitis. J Infect 1991; 21: IOI--I02.
3. Pearson G. The humoral response. In: Schlossberg D, Ed. Infectious mononucleosis. New York, Springer Verlag, 1989: 89-99.
Ventriculoperitoneal shunt-associated infection
Accepted for publication 28 May 1991 Sir, I read with interest the unusual cause of ventriculoperitoneal shunt-associated infection reported by Burnett et al. 1 Presumably the cerebrospinal fluid (CSF) was not examined before shunt removal because of the lack of evidence of meningitis, though I believe that it is wise to aspirate fluid from the shunt reservoir in all cases where shunt removal for infection is contemplated. H a d C S F been examined preoperatively in this case it is likely that the organisms would have been detected. T h e important implication is that shuntassociated infections caused by organisms such as meningococci and gonococci can be treated successfully without recourse to shunt removal, 2 as they appear unable to colonise the shunt material in the same way as coagulase-negative staphylococci. Also, there is to m y knowledge one other case of Neisseria gonorrhoeae shunt infection in the l i t e r a t u r e ) T h i s occurred in a 2 I - y e a r - o l d female following a spontaneous abortion. She was successfully treated with intravenous penicillin 4 megaunits 4-hourly for 12 days without shunt removal. Incidentally, the mortality rate (deaths in the infected group) of 34 % reported by Walters et al., 4 is taken f r o m a retrospective study begun in 196o and involving several modes of treatment. O u r understanding of shunt infections has improved since then, and deaths directly due to this cause are u n c o m m o n . Institute of Child Health, 30 Guilford Street, London W C I N IEH, U.K.
R. Bayston References
i. Burnett IA, Denton K, Sutcliffe J. Cerebrospinal fluid shunt infection: an unusual case. J Infect 1991; 2I: 205-206. 2. Bayston R. Hydrocephalus Shunt Infections. London: Chapman and Hall Medical, 1989: 46, lO4, 124. 3. Noble RC, Cooper RM. Gonococcal meningitis and ventriculitis in the presence of a ventriculoperitoneal shunt. Sex Transm Dis 1977; 4: 9-1I. 4. Waiters BC, Hoffman HJ, Hendrick EB, Humphreys RP. Cerebrospinal fluid shunt infection: influence on management and subsequent outcome. J Neurosurg 1984; 6o: 1014--1021.
R e c u r r e n t p l a s m o d i u m ovale i n f e c t i o n f r o m P a p u a N e w G u i n e a - - c h l o r o q u i n e r e s i s t a n c e or i n a d e q u a t e p r i m a q u i n e t h e r a p y ?
Accepted for publication 28 May 1991 Sir, T h e incidence of malaria in the U . K . has risen steadily during the last decade with 2000 cases now reported annually with a significant n u m b e r of deaths. 1 Rapidly
343
References I. Bhatti N, Larson E, Hickey M, Seal D. Encephalitis due to Epstein-Barr virus. J Infect 199o; 20 : 69-72. 2. Sanyal D, Kudesia G, Young M. Epstein-Barr virus encephalitis. J Infect 1991; 21: IOI--I02.
3. Pearson G. The humoral response. In: Schlossberg D, Ed. Infectious mononucleosis. New York, Springer Verlag, 1989: 89-99.
Ventriculoperitoneal shunt-associated infection
Accepted for publication 28 May 1991 Sir, I read with interest the unusual cause of ventriculoperitoneal shunt-associated infection reported by Burnett et al. 1 Presumably the cerebrospinal fluid (CSF) was not examined before shunt removal because of the lack of evidence of meningitis, though I believe that it is wise to aspirate fluid from the shunt reservoir in all cases where shunt removal for infection is contemplated. H a d C S F been examined preoperatively in this case it is likely that the organisms would have been detected. T h e important implication is that shuntassociated infections caused by organisms such as meningococci and gonococci can be treated successfully without recourse to shunt removal, 2 as they appear unable to colonise the shunt material in the same way as coagulase-negative staphylococci. Also, there is to m y knowledge one other case of Neisseria gonorrhoeae shunt infection in the l i t e r a t u r e ) T h i s occurred in a 2 I - y e a r - o l d female following a spontaneous abortion. She was successfully treated with intravenous penicillin 4 megaunits 4-hourly for 12 days without shunt removal. Incidentally, the mortality rate (deaths in the infected group) of 34 % reported by Walters et al., 4 is taken f r o m a retrospective study begun in 196o and involving several modes of treatment. O u r understanding of shunt infections has improved since then, and deaths directly due to this cause are u n c o m m o n . Institute of Child Health, 30 Guilford Street, London W C I N IEH, U.K.
R. Bayston References
i. Burnett IA, Denton K, Sutcliffe J. Cerebrospinal fluid shunt infection: an unusual case. J Infect 1991; 2I: 205-206. 2. Bayston R. Hydrocephalus Shunt Infections. London: Chapman and Hall Medical, 1989: 46, lO4, 124. 3. Noble RC, Cooper RM. Gonococcal meningitis and ventriculitis in the presence of a ventriculoperitoneal shunt. Sex Transm Dis 1977; 4: 9-1I. 4. Waiters BC, Hoffman HJ, Hendrick EB, Humphreys RP. Cerebrospinal fluid shunt infection: influence on management and subsequent outcome. J Neurosurg 1984; 6o: 1014--1021.
R e c u r r e n t p l a s m o d i u m ovale i n f e c t i o n f r o m P a p u a N e w G u i n e a - - c h l o r o q u i n e r e s i s t a n c e or i n a d e q u a t e p r i m a q u i n e t h e r a p y ?
Accepted for publication 28 May 1991 Sir, T h e incidence of malaria in the U . K . has risen steadily during the last decade with 2000 cases now reported annually with a significant n u m b e r of deaths. 1 Rapidly
