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Allonen S, Aittoniemi J, Vuorialho M, Närhi L, Panula K, Vuento R, Honkaniemi J. Streptococcus intermedius causing primary bacterial ventriculitis in a patient with severe periodontitis - a case report. BMC Neurol 2024; 24:112. [PMID: 38580923 PMCID: PMC10996266 DOI: 10.1186/s12883-024-03604-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 03/17/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Streptococcus intermedius is a member of the S. anginosus group and is part of the normal oral microbiota. It can cause pyogenic infections in various organs, primarily in the head and neck area, including brain abscesses and meningitis. However, ventriculitis due to periodontitis has not been reported previously. CASE PRESENTATION A 64-year-old male was admitted to the hospital with a headache, fever and later imbalance, blurred vision, and general slowness. Neurological examination revealed nuchal rigidity and general clumsiness. Meningitis was suspected, and the patient was treated with dexamethasone, ceftriaxone and acyclovir. A brain computer tomography (CT) scan was normal, and cerebrospinal fluid (CSF) Gram staining and bacterial cultures remained negative, so the antibacterial treatment was discontinued. Nine days after admission, the patient's condition deteriorated. The antibacterial treatment was restarted, and a brain magnetic resonance imaging revealed ventriculitis. A subsequent CT scan showed hydrocephalus, so a ventriculostomy was performed. In CSF Gram staining, chains of gram-positive cocci were observed. Bacterial cultures remained negative, but a bacterial PCR detected Streptococcus intermedius. An orthopantomography revealed advanced periodontal destruction in several teeth and periapical abscesses, which were subsequently operated on. The patient was discharged in good condition after one month. CONCLUSIONS Poor dental health can lead to life-threatening infections in the central nervous system, even in a completely healthy individual. Primary bacterial ventriculitis is a diagnostic challenge, which may result in delayed treatment and increased mortality.
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Affiliation(s)
| | - Janne Aittoniemi
- Department of Clinical Microbiology, Fimlab laboratories, Arvo Ylpon katu 4, 33520, Tampere, Finland.
| | - Matti Vuorialho
- Department of Radiology, Vaasa Central Hospital, Vaasa, Finland
| | - Lassi Närhi
- Department of Physical and Rehabilitation Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | - Kari Panula
- Department of Oral and Maxillofacial Surgery, Vaasa Central Hospital, Vaasa, Finland
| | - Risto Vuento
- Department of Clinical Microbiology, Fimlab laboratories, Arvo Ylpon katu 4, 33520, Tampere, Finland
| | - Jari Honkaniemi
- Department of Neurology, Vaasa Central Hospital, Vaasa, Finland
- Tampere University Hospital, Tampere and Turku University, Turku, Finland
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Maheshwarappa HM, Rai AV. A Rare Case of Primary Pyogenic Ventriculitis in a Patient with Community-acquired Meningitis. Indian J Crit Care Med 2022; 26:874-876. [PMID: 36864867 PMCID: PMC9973179 DOI: 10.5005/jp-journals-10071-24273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Pyogenic ventriculitis is defined as the inflammation of the ependymal lining of the cerebral ventricular system. It is characterized by the presence of suppurative fluid in the ventricles. It mostly affects neonates and children but rarely can be seen in adult population. In adults, it usually affects the elderly population. It is usually healthcare associated and occurs secondary to ventriculoperitoneal shunt, external ventricular drain, intrathecal drug delivery, brain stimulation devices, and neurosurgical intervention. Primary pyogenic ventriculitis though rare should be considered as one of the differential diagnoses in patients who do not improve despite an appropriate antibiotic regimen in bacterial meningitis. Our case report on primary pyogenic ventriculitis secondary to community-acquired bacterial meningitis in an elderly diabetic male patient illustrates the importance of utilization of multiplex polymerase chain reaction (PCR), repeated neuroimaging, and prolonged course of antibiotics for the successful management and outcome. How to cite this article Maheshwarappa HM, Rai AV. A Rare Case of Primary Pyogenic Ventriculitis in a Patient with Community-acquired Meningitis. Indian J Crit Care Med 2022;26(7):874-876.
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Affiliation(s)
- Harish Mallapura Maheshwarappa
- Department of Critical Care Medicine, Mazumdar Shaw Medical Center, Bengaluru, Karnataka, India,Harish Mallapura Maheshwarappa, Department of Critical Care Medicine, Mazumdar Shaw Medical Center, Bengaluru, Karnataka, India, Phone: +91 8095218493, e-mail:
| | - Akshatha V Rai
- Department of Critical Care Medicine, Narayana Hrudayalaya, Bengaluru, Karnataka, India
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Adhikari P, Antala D, Pyakuryal B, Muhammed A, Pudasainee P, Friedman H, Ezepue CJ. Community-Acquired Meningitis Complicated by Pyogenic Ventriculitis: A Case Report. Cureus 2022; 14:e23907. [PMID: 35530893 PMCID: PMC9077952 DOI: 10.7759/cureus.23907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 11/05/2022] Open
Abstract
Ventriculitis is the inflammation of the ependymal lining of the ventricles in the brain which usually occurs as a complication of meningitis, intraventricular devices, intracranial surgery, or brain abscess. Common clinical features include fever, altered mental status, headache, and neck rigidity. Some commonly associated organisms are Streptococcus, gram-negative Bacillus, Staphylococcus, and Meningococcus. Here, we report the case of a 57-year-old female presenting with fever, headache, and altered mental status, along with positive physical examination findings of Kernig’s and Brudzinski’s signs without any focal neurological deficits. Cerebrospinal fluid analysis findings were consistent with bacterial infection with neutrophilic leukocytosis, high protein, and low glucose. The blood culture was positive for Streptococcus pneumoniae. Magnetic resonance imaging was negative for enhancement of the meninges but showed fluid-filled layering in the ventricles consistent with pyogenic ventriculitis. The patient improved clinically within three days of initiation of empiric antibiotics.
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Guedes S, Bertrand-Gerentes I, Evans K, Coste F, Oster P. Invasive meningococcal disease in older adults in North America and Europe: is this the time for action? A review of the literature. BMC Public Health 2022; 22:380. [PMID: 35197024 PMCID: PMC8864456 DOI: 10.1186/s12889-022-12795-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neisseria meningitidis is an encapsulated Gram-negative diplococcus that asymptomatically colonises the upper respiratory tract in up to 25% of the population (mainly adolescents and young adults). Invasive meningococcal disease (IMD) caused by Neisseria meningitidis imposes a substantial public health burden,. The case fatality rate (CFR) of IMD remains high. IMD epidemiology varies markedly by region and over time, and there appears to be a shift in the epidemiology towards older adults. The objective of our review was to assess the published data on the epidemiology of IMD in older adults (those aged ≥ 55 years)in North America and Europe. Such information would assist decision-makers at national and international levels in developing future public health programmes for managing IMD. METHODS A comprehensive literature review was undertaken on 11 August 2020 across three databases: EMBASE, Medline and BIOSIS. Papers were included if they met the following criteria: full paper written in the English language; included patients aged ≥ 56 years; were published between 1/1/2009 11/9/2020 and included patients with either suspected or confirmed IMD or infection with N. meningitidis in North America or Europe. Case studies/reports/series were eligible for inclusion if they included persons in the age range of interest. Animal studies and letters to editors were excluded. In addition, the websites of international and national organisations and societies were also checked for relevant information. RESULTS There were 5,364 citations identified in total, of which 76 publications were included in this review. We identified that older adults with IMD were mainly affected by serogroups W and Y, which are generally not the predominant strains in circulation in most countries. Older adults had the highest CFRs, probably linked to underlying comorbidities and more atypical presentations hindering appropriate timely management. In addition, there was some evidence of a shift in the incidence of IMD from younger to older adults. CONCLUSIONS The use of meningococcal vaccines that include coverage against serogroups W and Y in immunization programs for older adults needs to be evaluated to inform health authorities' decisions of the relative benefits of vaccination and the utility of expanding national immunization programmes to this age group.
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Affiliation(s)
- Sandra Guedes
- Sanofi Pasteur, 14 Espace Henry Vallée, 69007, Lyon, France
| | | | | | - Florence Coste
- Sanofi Pasteur, 14 Espace Henry Vallée, 69007, Lyon, France
| | - Philipp Oster
- Sanofi Pasteur, 14 Espace Henry Vallée, 69007, Lyon, France.
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Sekar A, Datta D, Sahu R, Sahoo T. Burkholderia cepacia causing intraventricular empyema: A rare presentation in preterm neonate. J Pediatr Neurosci 2022. [DOI: 10.4103/jpn.jpn_133_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Hong S, Yang Y, Zhang Q, Zhuo S, Wang L. Recurrent primary pyogenic ventriculitis in an adult woman: a case report. BMC Neurol 2021; 21:401. [PMID: 34666698 PMCID: PMC8525037 DOI: 10.1186/s12883-021-02422-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 09/29/2021] [Indexed: 11/22/2022] Open
Abstract
Background Recurrent primary pyogenic ventriculitis has not been reported previously. We present a unique case of recurrent primary pyogenic ventriculitis in an adult. And we believe that our study makes a significant contribution to the literature. Case presentation An adult woman with uncontrolled diabetes experienced two episodes of pyogenic ventriculitis caused by Escherichia coli over 4 years. She had typical imaging features, and the source of infection was undetermined. After antibiotic treatment, she recovered fully. Conclusions Early recognition and therapy will improve patient prognosis.
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Affiliation(s)
- Shanyan Hong
- Department of Clinical Nutrition, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, Fujian, China.,Department of Neurology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, Fujian, China
| | - Yingxia Yang
- Department of Neurology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, Fujian, China
| | - Qianying Zhang
- Department of Medical Imaging, the 910th hospital of the People's Liberation Army, Quanzhou, 362000, Fujian, China
| | - Shitu Zhuo
- Department of Neurology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, Fujian, China
| | - Lingxing Wang
- Department of Neurology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, 362000, Fujian, China.
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Jayendrakumar CI, Ganesan DB, Thampi SJ, Natarajan V. Primary pyogenic ventriculitis caused by Streptococcal pneumoniae in adults. J Family Med Prim Care 2019; 8:3745-3747. [PMID: 31803684 PMCID: PMC6881931 DOI: 10.4103/jfmpc.jfmpc_688_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 09/17/2019] [Accepted: 10/09/2019] [Indexed: 11/25/2022] Open
Abstract
Primary pyogenic ventriculitis is more commonly manifested in children. Its presentation in adults due to Streptococcus pneumonia is rarely reported. It is mainly due to adequate vaccination cover and initiation of appropriate antibiotics. Ventriculitis is one of the complications of bacterial meningitis, requires long-term antibiotics and surgical intervention. Here, we are reporting a 67-year-old diabetic lady presented with a decrease in sensorium, seizure, and fever, diagnosed as bacterial ventriculitis. Her cerebro spinal fluid (CSF) picture suggestive of pyogenic meningitis, CSF, blood culture grew Streptoccous pneumoniae; MRI revealed –ventriculitis. She was treated with Injection Ceftriaxazone for 6 week duration. Serial MRI showed clearing of ventricular debris and she improved. This highlights the atypical presentation of pyogenic meningitis without nuchal rigidity, status epilepticus, and clinical improvement without the need of surgical intervention.
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Affiliation(s)
- Chavada I Jayendrakumar
- Department of Medicine- Endocrinology, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Dinesh B Ganesan
- Department of Medicine- Endocrinology, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Siddhant J Thampi
- Department of Medicine- Endocrinology, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - Vasanthi Natarajan
- Department of Medicine- Endocrinology, Pondicherry Institute of Medical Sciences, Puducherry, India
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