1
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
2
|
Hostettler IC, Lange N, Schwendinger N, Ambler G, Hirle T, Frangoulis S, Trost D, Gempt J, Kreiser K, Meyer B, Winter C, Wostrack M. VPS dependency after aneurysmal subarachnoid haemorrhage and influence of admission hyperglycaemia. Eur Stroke J 2023; 8:301-308. [PMID: 37021154 PMCID: PMC10069185 DOI: 10.1177/23969873221147087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 12/05/2022] [Indexed: 12/31/2022] Open
Abstract
Introduction Hydrocephalus after aneurysmal subarachnoid haemorrhage (aSAH) is a common complication which may lead to insertion of a ventriculoperitoneal shunt (VPS). Our aim is to evaluate a possible influence of specific clinical and biochemical factors on VPS dependency with special emphasis on hyperglycaemia on admission. Patients and methods Retrospective analysis of a monocentric database of aSAH patients. Using univariable and multivariable logistic regression analysis we evaluated factors influencing VPS dependency, with a special focus on hyperglycaemia on blood sample within 24 h of admission, dichotomised at 126 mg/dl. Factors evaluated in the univariable analysis were age, sex, known diabetes, Hunt and Hess grade, Barrow Neurological Institute scale, treatment modality, extra-ventricular drain (EVD) insertion, complications (rebleeding, vasospasm, infarction, decompressive craniectomy, ventriculitis), outcome variables and laboratory parameters (glucose, C-reactive protein, procalcitonin). Results We included 510 consecutive patients treated with acute aSAH requiring a VPS (mean age 58.2 years, 66% were female). An EVD was inserted in 387 (75.9%) patients. In the univariable analysis, VPS dependency was associated with hyperglycaemia on admission (OR 2.56, 95%CI 1.58-4.14, p < 0.001). In the multivariable regression analysis after stepwise backward regression, factors associated with VPS dependency were hyperglycaemia >126 mg/dl on admission (OR 1.93, 95%CI 1.13-3.30, p = 0.02), ventriculitis (OR 2.33, 95%CI 1.33-4.04, p = 0.003), Hunt and Hess grade (overall p-value 0.02) and decompressive craniectomy (OR 2.68, 95%CI 1.55-4.64, p < 0.001). Conclusion Hyperglycaemia on admission was associated with an increased probability of VPS placement. If confirmed, this finding might facilitate treatment of these patients by accelerating insertion of a permanent draining system.
Collapse
Affiliation(s)
- Isabel Charlotte Hostettler
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Neurosurgery, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Nicole Lange
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Nina Schwendinger
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Gareth Ambler
- Department of Statistical Science, University College London, London, UK
| | - Theresa Hirle
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Samira Frangoulis
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Dominik Trost
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Jens Gempt
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Kornelia Kreiser
- Department of Neuroradiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christof Winter
- Institute of Clinical Chemistry and Pathobiochemistry, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Maria Wostrack
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| |
Collapse
|
3
|
Wassef C, Johnson A, Stone J. Unusual case of spinal subdural empyema with ventriculitis managed conservatively with lumbar drain. BMJ Case Rep 2022; 15:e247156. [PMID: 35228235 PMCID: PMC8886382 DOI: 10.1136/bcr-2021-247156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2022] [Indexed: 11/04/2022] Open
Abstract
It has long been believed that spinal subdural empyemas (SDEs) with neurological symptoms result in death if operative intervention is not performed. We present a case of addressing an extensive spinal SDE with a minimally invasive procedure: a bedside lumbar drain. Our patient is a 67-year-old man with medical history significant for type I diabetes who presented 2 weeks after a right shoulder steroid injection with septic arthritis. An MRI was obtained for back pain which revealed spinal SDE from the cervical to lumbosacral spine. Given patient's acute sepsis, haemodynamic instability, and extent of empyema, we placed a lumbar drain for decompression. The patient had a prolonged complicated hospital course. Imaging 2 months later revealed interval decrease in the spinal SDE. Although this severe septic event left the patient with significant deficits, he was able to return to ambulation without surgical intervention.
Collapse
Affiliation(s)
- Catherine Wassef
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Angelique Johnson
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| | - Jonathan Stone
- Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York, USA
| |
Collapse
|
4
|
Amen MM, Zaher A, Badr HI, Elshirbiny MF, Elnaggar AM, Khalil AF. Ventriculosubgaleal shunt as a proposed technique for post-infectious hydrocephalus. Childs Nerv Syst 2022; 38:2155-2162. [PMID: 36214898 PMCID: PMC9617840 DOI: 10.1007/s00381-022-05661-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 09/03/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The management of post-infectious hydrocephalus (PIH) remains challenging for neurosurgeons. It requires a temporary diversion procedure till the normalization of CSF parameters prior to the permanent one. Ventriculosubgaleal shunt (VSGS) was widely used in pediatric cases with post-hemorrhagic hydrocephalus (PHH). However, its role in PIH is still lacking. This study was done to elucidate the safety and efficacy of VSGS as a temporary CSF diversion procedure before the permanent one in patients with PIH. PATIENTS AND METHODS This retrospective investigation analyzed the data of 50 consecutive cases who underwent VSGS for PIH. RESULTS The age of the included patients ranged between 1 and 10 months. Twenty-six cases had meningitis and or ventriculitis (52%), while the remaining had shunt infection. At follow-up, arresting of hydrocephalus was noted in ten patients (20%), while another 36 cases required the permanent diversion procedure within 35 days. Regarding the shunt complications, scalp infection, tissue breakdown, and shunt exposure were encountered in ten cases (20%), while CSF leakage was noted in 12 cases (24%). Shunt migration was noted in only two patients (4%). Shunt revision was needed in 16 cases (32%). Mortality was encountered in four cases (8%) because of sepsis. Risk factors for morbimortality included younger age, lower weight, male gender, and meningitis and or ventriculitis. CONCLUSION VSGS is a safe and effective procedure in infants awaiting definitive VPS for postinfectious hydrocephalus. It was proven that VSGS has shortened the hospital stay and the economic burden on the country.
Collapse
Affiliation(s)
| | - Ahmed Zaher
- Neurosurgery Department, Mansoura University, Mansoura, Egypt
| | | | | | | | - Amr Farid Khalil
- Neurosurgery Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| |
Collapse
|
5
|
Abstract
INTRODUCTION Chryseobacterium arthrosphaerae is a gram-negative bacteria, known for its intrinsic multidrug resistance, which can lead to treatment difficulties. PATIENT CONCERNS A 56-year-old male had an indwelling external ventricular drainage catheter for 6 months and had been frequently treated with antibiotics for nosocomial infections. He showed cerebrospinal fluid pleocytosis and an abrupt fever during hospitalization. DIAGNOSIS He was diagnosed as a ventriculitis caused by Chryseobacterium arthrosphaerae (C arthrosphaerae). INTERVENTION Initially, we used ciprofloxacin as the backbone in combination with minocycline (and rifampin). However, fever and pleocytosis persisted, and improvement was slow. We then switched the minocycline and rifampin regiment to trimethoprim/sulfamethoxazole. Following this switch of antibiotics, the patient's pleocytosis rapidly improved, allowing the replacement of his external ventricular drainage catheters. C arthrospharae was no longer growing in cerebrospinal fluid and he was recovered from ventriculitis. OUTCOMES The patient remains alive without any incidence of C arthrosphaerae recurrence. CONCLUSION We propose trimethoprim/sulfamethoxazole alone or in combination with ciprofloxacin to be good candidates for the treatment of ventriculitis by C arthrosphaerae.
Collapse
Affiliation(s)
- Jae Hyoung Im
- Division of Infectious diseases, Department of Internal Medicine
| | | | | | | | - Young Kyoung Park
- Translation Research Center, Inha University College of Medicine, Incheon
| | - Hea Yoon Kwon
- Division of Infectious diseases, Department of Internal Medicine
| | - Moon-Hyun Chung
- Department of Internal Medicine, Seogwipo Medical Center, Jeju, Republic of Korea
| | - Ji Hyeon Baek
- Division of Infectious diseases, Department of Internal Medicine
| | - Jin-Soo Lee
- Division of Infectious diseases, Department of Internal Medicine
| |
Collapse
|
6
|
Abstract
To describe a fatal case of invasive Aspergillus flavus sinusitis in a 43-year old female with sickle cell disease (SCD) complicated by intracerebral aspergilloma and invasive Salmonella infection. Cerebral aspergilloma carries a very high mortality rate. The patient developed post-craniotomy intracerebral hemorrhage at the site of biopsy, Salmonella species sepsis and ventriculitis. She presented with a 2-month history of headache, dizziness, personality and behavioral changes, and vomiting. Initial clinical evaluation raised the suspicion of brain tumor. Brain magnetic resonance imaging revealed a left frontal, thick-walled ring-enhancing lesion with extensive surrounding edema suggestive of a neoplastic lesion, or a contiguous inflammatory or infectious process from the skull base. Despite early diagnosis and appropriate antifungal and surgical management, she eventually died from severe infection and respiratory arrest. In conclusion, invasive aspergillosis should be included in the differential diagnosis of SCD patients with central nervous system (CNS) lesions.
Collapse
Affiliation(s)
- Fawzia E Al Otaibi
- Department of Pathology and Laboratory Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia. E-mail.
| |
Collapse
|
7
|
López-Amor L, Viña L, Martín L, Calleja C, Rodríguez-García R, Astola I, Forcelledo L, Álvarez-García L, Díaz-Gómez C, Fernández-Domínguez J, Vázquez F, Escudero D. Infectious complications related to external ventricular shunt. Incidence and risk factors. Rev Esp Quimioter 2017; 30:327-333. [PMID: 28749123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Infectious complications related to external ventricular shunt (ICREVS) are a main problem in neurocritical intensive care units (ICU). The aim of the review is to assess the incidence of ICREVS and to analyse factors involved. METHODS Retrospective analysis, adult polyvalent ICU in a third level reference hospital. Patients carrying external ventricular shunt (DVE) were included. Those patients with central nervous system infection diagnosed prior DVE placement were excluded. RESULTS 87 patients were included with 106 DVE. Most common admittance diagnosis was subarachnoid haemorrhage (49.4%). 31 patients with 32 DVE developed an ICREVS. Infection rate is 19.5 per 1000 days of shunt for ICREVS and 14 per 1000 days for ventriculitis. 31.6% of the patients developed ICREVS and 25.3% ventriculitis. Patients who developed ICREVS presented higher shunt manipulations (2.0 ± 0.6 vs. 3.26 ± 1.02, p=0.02), shunt repositioning (0.1 ± 0.1 vs. 0.2 ± 0.1) and ICU and hospital stay (29.8 ± 4.9 vs 49.8 ± 5.2, p<0.01 y 67.4 ± 18.8 vs. 108.9 ± 30.2, p=0.02. Those DVE with ICREVS were placed for longer not only at infection diagnosis but also at removal (12.6 ± 2.1 vs. 18.3 ± 3.6 and 12.6 ± 2.1 vs. 30.4 ± 7.3 days, p<0.01). No difference in mortality was found. CONCLUSIONS One out of three patients with a DVE develops an infection. The risk factors are the number of manipulations, repositioning and the permanency days. Patients with ICREVS had a longer ICU and hospital average stay without an increase in mortality.
Collapse
Affiliation(s)
- L López-Amor
- Lucía López Amor, Servicio de Medicina Intensiva. Hospital Universitario Central de Asturias Avenida de Roma s/n 33011 Oviedo. Asturias, Spain.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Abstract
A 73-year-old man was admitted to our hospital with disturbance of consciousness, fever and headache. Cerebrospinal fluid (CSF) analysis revealed pleocytosis with neutrophil predominance, increased protein and low glucose. CSF and blood cultures yielded negative results. Antibiotics and antituberculous drugs were started for meningitis. An antimycotic was also added. The patient died from transtentorial hernia 99 days after admission. Autopsy revealed meningitis, ventriculitis and brain abscess, and Nocardia araoensis was detected in pus from the left lateral ventricle. This appears to represent the first report of N. araoensis meningitis complicated by ventriculitis and brain abscess.
Collapse
|
9
|
Abstract
Hydrocephalus is a common disorder of cerebral spinal fluid (CSF) physiology resulting in abnormal expansion of the cerebral ventricles. Infants commonly present with progressive macrocephaly whereas children older than 2 years generally present with signs and symptoms of intracranial hypertension. The classic understanding of hydrocephalus as the result of obstruction to bulk flow of CSF is evolving to models that incorporate dysfunctional cerebral pulsations, brain compliance, and newly characterised water-transport mechanisms. Hydrocephalus has many causes. Congenital hydrocephalus, most commonly involving aqueduct stenosis, has been linked to genes that regulate brain growth and development. Hydrocephalus can also be acquired, mostly from pathological processes that affect ventricular outflow, subarachnoid space function, or cerebral venous compliance. Treatment options include shunt and endoscopic approaches, which should be individualised to the child. The long-term outcome for children that have received treatment for hydrocephalus varies. Advances in brain imaging, technology, and understanding of the pathophysiology should ultimately lead to improved treatment of the disorder.
Collapse
Affiliation(s)
- Kristopher T Kahle
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Abhaya V Kulkarni
- Division of Neurosurgery, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - David D Limbrick
- Division of Neurosurgery, St Louis Children's Hospital, Washington University School of Medicine, St Louis, MO, USA
| | - Benjamin C Warf
- Department of Neurosurgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| |
Collapse
|