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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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2
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Şimşek F, Yevgi R, Yalçın A. Primary Bacterial Ventriculitis caused by Staphylococcus warneri. Rev Soc Bras Med Trop 2023; 56:e0631. [PMID: 36888786 PMCID: PMC9991105 DOI: 10.1590/0037-8682-0631-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 01/25/2023] [Indexed: 03/08/2023] Open
Affiliation(s)
- Fatma Şimşek
- Ataturk University, Faculty of Medicine, Department of Neurology, Erzurum, Turkey
| | - Recep Yevgi
- Ataturk University, Faculty of Medicine, Department of Neurology, Erzurum, Turkey
| | - Ahmet Yalçın
- Ataturk University, Faculty of Medicine, Department of Radiology, Erzurum, Turkey
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3
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Yoshida K, Chambers JK, Uchida K. Systemic Streptococcus agalactiae infection with meningo-ventriculitis in a Linnaeus's two-toed sloth (Choloepus didactylus). J Vet Med Sci 2022; 84:1417-1421. [PMID: 36058878 DOI: 10.1292/jvms.22-0317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A captive male Linnaeus's two-toed sloth died without any obvious clinical signs. At necropsy, multifocal ulceration at the lumbar and perianal skin, mitral valve vegetation, and multifocal hemorrhage in the leptomeninges were observed. Histopathologically, suppurative meningo-ventriculitis, dermatitis, and endocarditis characterized by severe neutrophilic infiltration were observed. Gram-positive cocci arranged in pairs or chains were present in these inflammatory lesions. Streptococcus agalactiae gene was detected in the skin, heart, and brain tissues by PCR and sequence analysis. These findings may indicate that S. agalactiae primarily infected the skin and then caused septicemia resulting in endocarditis and meningo-ventriculitis. The present case suggests that S. agalactiae infection can cause severe meningo-ventriculitis in two-toed sloth without any specific clinical signs.
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Affiliation(s)
- Kio Yoshida
- Laboratory of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - James K Chambers
- Laboratory of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Kazuyuki Uchida
- Laboratory of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
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4
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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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5
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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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6
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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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7
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Hikone M, Nagai K, Inoue K, Noji S, Sugiyama K, Hamabe Y. Invasive infection due to Streptococcus dysgalactiae subspecies equisimilis causing endocarditis and ventriculitis: A case report. Clin Case Rep 2021; 9:e04638. [PMID: 34484750 PMCID: PMC8405427 DOI: 10.1002/ccr3.4638] [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: 06/22/2021] [Revised: 07/07/2021] [Accepted: 07/08/2021] [Indexed: 11/06/2022] Open
Abstract
We aim to raise awareness of the role of Streptococcus dysgalactiae subsp. equisimilis (SDSE) in causing endovascular and central nervous system infections, and to promote recognition of SDSE as a pathogen that may cause serious invasive infections.
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Affiliation(s)
- Mayu Hikone
- Department of Emergency and Critical Care CenterTokyo Metropolitan Bokutoh HospitalTokyoJapan
| | - Ko Nagai
- Department of Emergency and Critical Care CenterTokyo Metropolitan Bokutoh HospitalTokyoJapan
| | - Ken Inoue
- Department of Emergency and Critical Care CenterTokyo Metropolitan Bokutoh HospitalTokyoJapan
| | - Saki Noji
- Department of Emergency and Critical Care CenterTokyo Metropolitan Bokutoh HospitalTokyoJapan
| | - Kazuhiro Sugiyama
- Department of Emergency and Critical Care CenterTokyo Metropolitan Bokutoh HospitalTokyoJapan
| | - Yuichi Hamabe
- Department of Emergency and Critical Care CenterTokyo Metropolitan Bokutoh HospitalTokyoJapan
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8
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Deghmane AE, Taha S, Taha MK. Global epidemiology and changing clinical presentations of invasive meningococcal disease: a narrative review. Infect Dis (Lond) 2021; 54:1-7. [PMID: 34459329 DOI: 10.1080/23744235.2021.1971289] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Neisseria meningitidis (the meningococcus) causes significant morbidity and mortality worldwide through an epidemic or sporadic invasive infections. The epidemiology of N. meningitidis is changing and unpredictable. Certain emerging meningococcal genotypes seem to be associated with increasing unusual clinical presentations. Indeed, early symptoms may vary and are frequently non-specific. However, atypical clinical forms including abdominal presentations, septic arthritis, and bacteremic pneumonia may lead to misdiagnosis and some are usually associated with higher case fatality rates due to delayed optimal management. Improving awareness of clinicians and public health specialists about these unusual but potentially severe presentations should help establish prompt diagnoses and provide appropriate management of cases. In this review, we described unusual panels of clinical presentations of invasive meningococcal disease linked to the recent changes in meningococcal epidemiology.
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Affiliation(s)
- Ala-Eddine Deghmane
- Institut Pasteur, Invasive Bacterial Infections Unit and National Reference Centre for Meningococci and Haemophilus Influenzae, Paris, France
| | - Samy Taha
- Institut Pasteur, Invasive Bacterial Infections Unit and National Reference Centre for Meningococci and Haemophilus Influenzae, Paris, France.,Faculty of Medicine, Université de Paris Sud, Le Kremlin-Bicêtre, France
| | - Muhamed-Kheir Taha
- Institut Pasteur, Invasive Bacterial Infections Unit and National Reference Centre for Meningococci and Haemophilus Influenzae, Paris, France
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9
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Kim KT, Baek SH, Lee SU, Kim JB, Kim JS. Primary ventriculitis presenting with isolated vestibular syndrome. J Neurol 2021; 268:4891-4893. [PMID: 34165629 DOI: 10.1007/s00415-021-10681-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/18/2021] [Accepted: 06/20/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Keun-Tae Kim
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, Republic of Korea
| | - Seol-Hee Baek
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, Republic of Korea
| | - Sun-Uk Lee
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, Republic of Korea. .,Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Jung Bin Kim
- Department of Neurology, Korea University Medical Center, 73 Goryeodae-ro, Seongbuk-gu, Seoul, Republic of Korea.,Department of Neurology, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Dizziness Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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10
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Ruiz Torres B, Ramos Paesa C, Rivero Salvador T, Marín Zaldivar C, Gil Pérez D. Enterococcus faecium meningitis secondary to epidural anesthesia. About a case and review of the literature. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 68:357-360. [PMID: 34130933 DOI: 10.1016/j.redare.2020.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/26/2020] [Indexed: 06/12/2023]
Abstract
Septic meningitis secondary to epidural anesthesia is a rare but serious complication that is usually related to exogenous contamination from inadequate aseptic techniques, so the most frequent microorganisms observed are S. aureus and S. salivarius. We describe the case of a woman who, after receiving epidural anesthesia for normal delivery, presented septic meningitis due to E. faecium with recurrence after antibiotic treatment, probably secondary to pyogenic ventriculitis undetected in the first episode. We highlight the rarity of the case, emphasizing the need for strict aseptic technique, and review the literature on the most appropriate treatment for this type of complication.
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Affiliation(s)
- B Ruiz Torres
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario Lozano-Blesa de Zaragoza, Zaragoza, Spain.
| | - C Ramos Paesa
- Unidad de Enfermedades Infecciosas, Hospital Universitario Miguel Servet de Zaragoza, Zaragoza, Spain
| | - T Rivero Salvador
- Servicio de Anestesiología y Reanimación, Hospital San Pedro de Logroño, La Rioja, Spain
| | | | - D Gil Pérez
- Unidad de Enfermedades Infecciosas, Hospital Universitario Miguel Servet de Zaragoza, Zaragoza, Spain
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11
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Ruiz Torres B, Ramos Paesa C, Rivero Salvador T, Marín Zaldívar C, Gil Pérez D. Enterococcus faecium meningitis secondary to epidural anesthesia. About a case and review of the literature. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2021; 68:357-360. [PMID: 33358426 DOI: 10.1016/j.redar.2020.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 06/16/2020] [Accepted: 06/26/2020] [Indexed: 06/12/2023]
Abstract
Septic meningitis secondary to epidural anesthesia is a rare but serious complication that is usually related to exogenous contamination from inadequate aseptic techniques, so the most frequent microorganisms observed are S. aureus and S. salivarius. We describe the case of a woman who, after receiving epidural anesthesia for normal delivery, presented septic meningitis due to E. faecium with recurrence after antibiotic treatment, probably secondary to pyogenic ventriculitis undetected in the first episode. We highlight the rarity of the case, emphasizing the need for strict aseptic technique, and review the literature on the most appropriate treatment for this type of complication.
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Affiliation(s)
- B Ruiz Torres
- Servicio de Anestesiología y Reanimación, Hospital Clínico Universitario Lozano Blesa de Zaragoza, Zaragoza, España.
| | - C Ramos Paesa
- Unidad de Enfermedades Infecciosas, Hospital Universitario Miguel Servet de Zaragoza, Zaragoza, España
| | - T Rivero Salvador
- Servicio de Anestesiología y Reanimación, Hospital San Pedro de Logroño, La Rioja, España
| | | | - D Gil Pérez
- Unidad de Enfermedades Infecciosas, Hospital Universitario Miguel Servet de Zaragoza, Zaragoza, España
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12
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Luque-Paz D, Revest M, Eugène F, Boukthir S, Dejoies L, Tattevin P, Le Reste PJ. Ventriculitis: A Severe Complication of Central Nervous System Infections. Open Forum Infect Dis 2021; 8:ofab216. [PMID: 34095339 PMCID: PMC8176394 DOI: 10.1093/ofid/ofab216] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ventriculitis, a dreaded complication of brain abscess, meningitis, and various neurosurgical procedures, has attracted limited attention in the medical literature. METHODS This is a retrospective, single-center study. We screened the medical files of all patients who had a brain imaging report that included the word "ventriculitis" during years 2005-2019. Only patients with clinical, microbiological, and imaging features of ventriculitis were included. Data were collected through a standardized questionnaire. RESULTS Ninety-eight patients fulfilled inclusion criteria: 42 women and 56 men, and the median age was 60 years (interquartile range, 48-68). The primary mechanism for ventriculitis was classified as follows: brain abscess (n = 29, 29.6%), meningitis (n = 27, 27.6%), intraventricular catheter-related (n = 17, 17.3%), post-neurosurgery (n = 13, 13.3%), and hematogenous (n = 12, 12.2%). The main neuroimaging features were intraventricular pus (n = 81, 82.7%), ependymal enhancement (n = 70, 71.4%), and intraventricular loculations (n = 15, 15.3%). The main pathogens were streptococci (n = 44, 44.9%), Gram-negative bacilli (n = 27, 27.6%), and staphylococci (n = 15, 15.3%). In-hospital and 1-year mortality rates were 30.6% (n = 30) and 38.8% (n = 38), respectively. Neurological sequelae were reported in 34 of 55 (61.8%) survivors, including cognitive impairment (n = 11), gait disturbances (n = 9), paresis (n = 7), behavior disorder (n = 6), and epilepsy (n = 5). On multivariate analysis, age >65 years, Glasgow Coma Scale score <13 at initial presentation, status epilepticus, hydrocephalus, and positive cerebrospinal fluid culture were associated with 1-year mortality. We built a scoring system to stratify patients with ventriculitis into low risk (12.5%), intermediate risk (36.5%), and high risk (71.4%) of death. CONCLUSIONS Ventriculitis is a severe complication of brain abscess, meningitis, or neurosurgery, with an in-hospital mortality rate of 30% and neurological sequelae in 60% of survivors.
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Affiliation(s)
- David Luque-Paz
- Infectious Diseases and Intensive Care Unit, Rennes University Hospital, Rennes, France
- Rennes University, Inserm, Bacterial Regulatory RNAs and Medicine, UMR_S 1230, Rennes, France
| | - Matthieu Revest
- Infectious Diseases and Intensive Care Unit, Rennes University Hospital, Rennes, France
- Rennes University, Inserm, Bacterial Regulatory RNAs and Medicine, UMR_S 1230, Rennes, France
- CIC-Inserm 1414, Rennes University Hospital, Rennes, France
| | - François Eugène
- Department of Neuroradiology, Rennes University Hospital, Rennes, France
| | - Sarrah Boukthir
- Bacteriology Department, Rennes University Hospital, Rennes, France
| | - Loren Dejoies
- Bacteriology Department, Rennes University Hospital, Rennes, France
| | - Pierre Tattevin
- Infectious Diseases and Intensive Care Unit, Rennes University Hospital, Rennes, France
- Rennes University, Inserm, Bacterial Regulatory RNAs and Medicine, UMR_S 1230, Rennes, France
- CIC-Inserm 1414, Rennes University Hospital, Rennes, France
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13
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Kondrat J, Ilyaguyev B, Stern J, Choe T, Greenstein J, Hahn B. Male with Altered Mental Status. Clin Pract Cases Emerg Med 2021; 5:131-133. [PMID: 33560974 PMCID: PMC7872607 DOI: 10.5811/cpcem.2020.12.50960] [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] [Received: 11/24/2020] [Accepted: 12/31/2020] [Indexed: 11/14/2022] Open
Abstract
Case Presentation A 62-year-old male presented to the emergency department with altered mental status and fever. Computed tomography of the head showed enlargement of the left lateral ventricle. Magnetic resonance imaging demonstrated debris and purulence in the ventricle along with edema and transependymal flow of cerebrospinal fluid surrounding both ventricles. Discussion The patient was diagnosed with ventriculitis. Ventriculitis is an uncommon but serious disease. Early recognition and treatment are essential.
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Affiliation(s)
- Jason Kondrat
- Staten Island University Hospital, Department of Emergency Medicine, Staten Island, New York
| | - Ben Ilyaguyev
- Staten Island University Hospital, Department of Emergency Medicine, Staten Island, New York
| | - Jonathan Stern
- Staten Island University Hospital, Department of Radiology, Staten Island, New York
| | - Teresa Choe
- Staten Island University Hospital, Department of Emergency Medicine, Staten Island, New York
| | - Josh Greenstein
- Staten Island University Hospital, Department of Emergency Medicine, Staten Island, New York
| | - Barry Hahn
- Staten Island University Hospital, Department of Emergency Medicine, Staten Island, New York
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14
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Mallon D, Dixon L, Campion T, Dawe G, Bhatia K, Kachramanoglou C, Kirmi O. Beyond the brain: Extra-axial pathology on diffusion weighted imaging in neuroimaging. J Neurol Sci 2020; 415:116900. [PMID: 32464349 DOI: 10.1016/j.jns.2020.116900] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/30/2020] [Accepted: 05/09/2020] [Indexed: 01/10/2023]
Abstract
Diffusion-weighted imaging (DWI) has a central role in the assessment of the brain parenchyma, particularly in the context of acute stroke. However, the applications of DWI extend far beyond the brain parenchyma and include the assessment of the extra-axial structures of the head and neck that are included in routine brain imaging. In this pictorial review, the added-value of DWI over other conventional sequences is illustrated through discussion of a broad range of disorders affecting the vasculature, skull, orbits, nasal cavity and salivary glands. This article highlights the requirement for all structures, both intra- and extra-axial, to be carefully reviewed on DWI.
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Affiliation(s)
- Dermot Mallon
- Imperial College Healthcare NHS Trust, Department of Imaging, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK.
| | - Luke Dixon
- Imperial College Healthcare NHS Trust, Department of Imaging, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - Tom Campion
- Imperial College Healthcare NHS Trust, Department of Imaging, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - Gemma Dawe
- Imperial College Healthcare NHS Trust, Department of Imaging, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - Kunwar Bhatia
- Imperial College Healthcare NHS Trust, Department of Imaging, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - Carolina Kachramanoglou
- Imperial College Healthcare NHS Trust, Department of Imaging, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
| | - Olga Kirmi
- Imperial College Healthcare NHS Trust, Department of Imaging, Charing Cross Hospital, Fulham Palace Road, London W6 8RF, UK
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15
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When a Stroke is not Just a Stroke: Escherichia Coli Meningitis with Ventriculitis and Vasculitis: A Case Report. J Crit Care Med (Targu Mures) 2020; 6:65-70. [PMID: 32104733 PMCID: PMC7029403 DOI: 10.2478/jccm-2020-0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 01/17/2020] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Community-acquired Escherichia coli ventriculitis is considered a rare condition. Central nervous system (CNS) infection due to gram-negative bacilli is usually associated with previous neurosurgical interventions. The recent publication of cases of Escherichia coli meningitis and ventriculitis suggests its prevalence may be underestimated by the literature. CASE PRESENTATION A case of community-acquired Escherichia coli CNS infection on a 58 year old patient presenting with altered consciousness but without neck stiffness, nor significant past medical history is reported. Imaging and lumbar puncture findings suggested a complex case of meningitis with associated ventriculitis and vasculitis. Escherichia coli was later identified in cultures. Subsequent multi-organ support in Intensive Care was required. The patient was treated with a prolonged course of intravenous antimicrobials guided by microbiology, resulting in some neurological recovery. The main challenges encountered in the management of the patient were the lack of clear recommendations on the duration of treatment and the potential development of multi-resistant organisms. CONCLUSION Bacterial central nervous system infections can have an atypical presentation, and an increasing number of cases of community-acquired ventriculitis have been reported. Early consideration should be given to use magnetic resonance imaging to help guide treatment. A long course of antibiotics is often required for these patients; however, the optimal duration for antimicrobial treatment is not well defined.
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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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Senda J, Adachi T, Tago M, Mori M, Imai H, Ogawa Y, Kawaguchi K. Acute Bilateral Oculomotor Nerve Palsy in an Adult Patient with Neisseria meningitidis. Intern Med 2019; 58:1639-1642. [PMID: 30713317 PMCID: PMC6599925 DOI: 10.2169/internalmedicine.2098-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 69-year-old woman was admitted to our hospital with a fever, dizziness, and headache caused by Neisseria meningitidis. After ceftriaxone was administered, she suddenly developed bilateral oculomotor nerve palsy. Intra-orbital magnetic resonance imaging using appropriate sequences revealed that her bilateral third intracranial nerves were enlarged and enhanced. She achieved complete recovery by two months after additional short-term treatment with intravenous immunoglobulin and methylprednisolone. Although intracranial nerve disorders that result from bacterial meningitis are most frequently reported in children, it is noteworthy that it can also cause focal intracranial nerve inflammation with ophthalmoparesis in N. meningitidis infection in adults.
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Affiliation(s)
- Joe Senda
- Department of Neurology and Rehabilitation, Komaki City Hospital, Japan
| | | | - Mayumi Tago
- Junior Resident, Komaki City Hospital, Japan
| | - Masaya Mori
- Department of General Internal Medicine, Komaki City Hospital, Japan
| | - Hajime Imai
- Department of Cardiology, Komaki City Hospital, Japan
| | | | - Katsuhiro Kawaguchi
- Department of Cardiology, Komaki City Hospital, Japan
- Department of General Internal Medicine, Komaki City Hospital, Japan
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Bajaj D, Agrawal A, Gandhi D, Varughese R, Gupta S, Regelmann D. Intraventricular empyema caused by Neisseria meningitidis. IDCases 2019; 15:e00503. [PMID: 30788218 PMCID: PMC6369236 DOI: 10.1016/j.idcr.2019.e00503] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/01/2019] [Accepted: 02/01/2019] [Indexed: 11/20/2022] Open
Abstract
Meningitis is defined as an inflammation of the protective covering of brain and spinal cord collectively called as meninges. Meningeal infection can be complicated by intraventricular empyema. There are 9 cases of intraventricular empyema described in the literature out of which only three are described to be caused by Neisseria meningitidis. We report the fourth rare case. A 61-year-old female with past medical history of diabetes and hypertension presented with the chief complaint of fever with chills and headache of 1-day duration. CT head did not reveal any acute abnormalities. Lumbar puncture was obtained and empiric IV antimicrobial agents were started. CSF analysis showed gram negative diplococci with culture growing Neisseria meningitidis suggesting meningococcal meningitis. Due to persistent headache and lethargy after complicated meningitis was suspected and MRI of brain was obtained which reflected a diagnosis of intraventricular empyema. Pyogenic ventriculitis also known as intraventricular empyema or ependymitis, is a defined as an inflammation of the ependymal lining of the cerebral ventricular system and is characterized by the presence of suppurative fluid in the ventricles. It is a health care associated complication and is often confused with meningitis due to the similar presentation. Therefore, persistent symptoms despite optimal antimicrobial therapy (therapeutic failure) should alarm the presence of pyogenic ventriculitis. This is the fourth case of intraventricular empyema reported secondary to Neisseria meningitidis. Our case reiterates that clinicians should maintain an index of suspicion for complicated meningitis in patients not responding to standard antimicrobial therapy.
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Affiliation(s)
- Divyansh Bajaj
- Department of Internal Medicine, Quinnipiac University Frank H. Netter MD School of Medicine/Saint Vincent's Medical Center, Bridgeport, CT, USA
| | - Ankit Agrawal
- Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School/Saint Peter's University Hospital, New Brunswick, NJ, USA
| | - Darshan Gandhi
- Department of Diagnostic Radiology, Quinnipiac University Frank H. Netter MD School of Medicine/Saint Vincent's Medical Center, Bridgeport, CT, USA
| | - Reba Varughese
- Department of Internal Medicine, Quinnipiac University Frank H. Netter MD School of Medicine/Saint Vincent's Medical Center, Bridgeport, CT, USA
| | - Sonali Gupta
- Department of Internal Medicine, Quinnipiac University Frank H. Netter MD School of Medicine/Saint Vincent's Medical Center, Bridgeport, CT, USA
| | - David Regelmann
- Department of Internal Medicine, Quinnipiac University Frank H. Netter MD School of Medicine/Saint Vincent's Medical Center, Bridgeport, CT, USA
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