A 7-year-old girl with a history of a VP shunt presents with a headache for 2 days and worsening fever. The patient’s mother states that the child had a shunt placed during her first year of life for congenital aqueductal stenosis. The patient is febrile in the ED, with a temperature of 38.6°C, but is nontoxic. Her other vital signs are: heart rate, 118 beats/min; respiratory rate, 20 breaths/min; blood pressure 98/62 mm Hg; and oxygen saturation, 100% on room air. Her physical examination is unremarkable except for a mildly erythematous throat. What are important points on your history that should be elicited for a patient with a VP shunt and fever? If you are concerned about a VP shunt infection, what laboratory studies should be ordered? Do you need to order any imaging studies to look for a possible shunt malfunction? Should you call this child’s neurosurgeon?
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