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Primary Ventriculitis Caused by N. Meningitidis: Case Report and Review of the Literature

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Primary Ventriculitis Caused by N. Meningitidis: Case Report and Review of the Literature Primary Ventriculitis caused by N. meningitidis: Case report and review of the literature Gronthoud FA1, Hassan I1, Thornber M2, Gill N2, Newton P3 Dept of Microbiology1, Dept of Acute Medicine2 and National Aspergillosis Centre3, University Hospital of South Manchester, Manchester, United Kingdom BACKGROUND RESULTS REFERENCES Pyogenic ventriculitis is a recognized Seven adults (five male) with ventriculitis are 1 Lee HK.; Unilateral pyogenic ventriculitis.; J Nucl Med. complication of meningitis, brain abscess, described. Median age was sixty-three years. 1977 Apr;18(4):403. intraventricular surgery and presence of Headache was present in four cases but only one 2 Barloon TJ et al.; Cerebral ventriculitis: MR findings.; J intraventricular drains. There may be clinical patient showed signs of meningism. Blood Comput Assist Tomogr. 1990 Mar-Apr;14(2):272-5. evidence of sepsis, meningism or it can be cultures were positive in four patients, organisms 3 Vajramani GV et al.; Primary ventriculitis caused by clinically indolent. There are no well-defined were identified in five CSF cultures (See table) . Streptococcus intermedius.; Br J Neurosurg. 2007 Jun;21(3):293-6. definitions for ventricular infections and pyogenic CT findings consisted of ependymal ventriculitis has been variably referred to as enhancement, increased ventricular densities and 4 Ito H et al.; Listeria monocytogenes meningoencephalitis presenting with hydrocephalus and ventriculitis.; Intern ependymitis, ventricular empyema, pyocephalus hydrocephalus. MRI findings consisted of Med. 2008;47(4):323-4. Epub 2008 Feb 15. or ventriculitis. Primary pyogenic ventriculitis is intraventricular signal abnormalities and 5 Kobayashi H et al.; Pyogenic ventriculitis following rare and few cases have been described. ependymal enhancement. MRI may help urosepsis caused by Escherichia coli.; BMJ Case Rep. 2013 We present a case report and overview of all adult differentiate between blood and pus. Treatment Oct 23;2013. MRI cerebrum of our patient showing fluid primary pyogenic ventriculitis cases reported in duration was documented in four patients; three level in the occipital horns bilaterally, no 6 Marinelli L et al.; Diffusion magnetic resonance imaging the English literature. of whom survived had treatment duration diagnostic relevance in pyogenic ventriculitis with an epyndymal enhancement seen. Diffuse atypical presentation: a case report.; BMC Res Notes. 2014 between 42 and 49 days. Weighted Imaging (Picture) showing marked Mar 14;7:149 hyperintensity CASE CONCLUSIONS Table. Clinical characteristics and outcome of seven patients with primary pyogenic ventriculitis A fifty-five year old male presented acutely with We report the first case of pyogenic ventriculitis Age Gender Presenting symptoms Meningism Location Causative Agent Specimen CSF pleocytosis Antibiotic Duration Ventricular Outco Ref. fever, swelling and erythema of right foot and Treatment antibiotic Drainage me caused by N. meningitidis. Primary pyogenic treatment ankle and a headache without meningism. CT (days) brain showed intraventricular haemorrhage in the ventriculitis is rare with various clinical 81 F Right hemiplegia, aphasia no Left lateral S. aureus CSF not performed Amoxicillin, 3 no died 1 ventricle bloodculture not chloramphenicol occipital horns of both lateral ventricles and MRI presentations caused by different bacterial performed 39 M Fatigue, fever, rigors, yes Left lateral E. faecalis, E. coli, Bloodculture yes Unknown Unknown yes, ventricular Unkno 2 brain suggestive of pus rather than blood, species. There is insufficient data to suggest frontal headache, nuchal ventricle Peptostreptococcus sp. shunt wn rigidity, facial paresis, consistent with ventriculitis. Blood culture grew antimicrobial treatment duration. Ventricular right extensor plantar Peptostreptococcus sp. CSF drainage may be required. response N. meningitidis belonging to serogroup B. Broad- 63 M Headaches, feeling no Right S. intermedius CSF, 16s PCR yes Cefotaxime 200 mg 6 42 EVD, Survive 3 intermittently hot and lateral (CSF collected hourly + d spectrum antibiotics were switched to third sweaty, clumsiness, ventricle after start Abx) metronidazol 500 mg generation cephalosporin and rifampicin given for unsteadiness, diarrhoea 8 hourly and fever. Bloodcultures rifampicine 600 mg a few days. Patient was discharged home on negative OD later added (given for 14 days) outpatient antibiotic therapy to complete six 62 M Fever + headache after trip no right L. monocytogenes CSF yes ampicillin 12 g daily, unknown EVD, later Survive 4 to Japan lateral bloodculture vancomycin converted to d weeks treatment. ventricle negative 1 g OD, ceftriaxone 2 VP drain g OD. Vancomycin and Ceftriaxone later converted to gentamicin 180 mg OD, on day 9 MATERIALS/METHODS 78 F Acute onset of back pain no lateral E. coli bloodculture, LP failed ceftriaxone unknown biventricular Survive 5 and mild altered mental ventricles urine culture, drainage d status pus ventricle A PubMed search was performed using the terms 66 M Fever, anxiousness, no lateral Methicillin Resistant bloodculture yes vancomycin initially 49 no Survive 6 ependymitis, ventricular empyema, pyocephalus restlessness, psychomotor ventricles S. aureus 1g/48h, increased to d Gram stain of blood culture retardation, generalized 1.5g/day followed by and ventriculitis. Filter was set for Adults and weakness and linezolid from our patient showing suction-like mouth Language. Articles where pyogenic ventriculitis dyskinesias characteristic gram- 55 M Intermittent occipital no lateral N. meningitidis bloodculture LP not one dose 42 no suvived Our was a complication of well-known risk factors headache and clinical ventricles performed due piperacillin/tazobacta patient negative, coffee-bean suspicion of DVT right to raised INR m 4.5 g, one dose were excluded. Six cases of primary pyogenic shaped diplococci ankle gentamicin 450 mg and one dose ventriculitis in adults were identified. clarithromycin 500 mg followed by ceftriaxone 2 g BD .
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