BackgroundCommunity-acquired gram-negative bacillary meningitis is rare to occur without preexisting conditions like trauma, organ dysfunction, and immunocompromised state, and very few case reports with Escherichia coli have been described in literature till now. Presence of ventriculitis along with meningitis makes the incidence further sparse.Case presentationA review of literature identified a total of only 45 community-acquired E. coli meningitis from 1945 till to date. Here, we have described a case of community-acquired E. coli meningitis with ventriculitis in an adult with past history of completely repaired CSF leak secondary to trauma nearly 23 years ago, without current radiological evidence of persistent CSF leak and therefore described as spontaneously acquired. Post-contrast T1 images of MRI were suggestive of subtle ependymal enhancement of ventricles, and patient was treated in lines of ventriculitis. Initial CSF was suggestive of acute pyogenic meningitis, and the organism grown was pan-sensitive E. coli. Patient was treated with antibiotics according to the culture sensitivity pattern and was given a prolonged course of 6 weeks of antibiotic therapy in view of ventriculitis.ConclusionCommunity-acquired E. coli meningitis with possible ventriculitis in adults is described as a rare entity and is likely to be underrated and under-recognized.
Transcatheter mitral valve repair with the MitraClip, a catheter-based percutaneous edge-to-edge repair technique to correct mitral regurgitation (MR), has been demonstrated in Western studies to be an effective and safe MR treatment strategy. However, randomised clinical trial data on its use in Asian-Pacific patients is limited. Hence, the Asian Pacific Society of Cardiology convened an expert panel to review the available literature on MitraClip and to develop consensus recommendations to guide clinicians in the region. The panel developed statements on the use of MitraClip for the management of degenerative MR, functional MR, and other less common indications, such as acute MR, dynamic MR, hypertrophic obstructive cardiomyopathy, and MR after failed surgical repair. Each statement was voted on by each panel member and consensus was reached when 80% of experts voted ‘agree’ or ‘neutral’. This consensus-building process resulted in 10 consensus recommendations to guide general cardiologists in the evaluation and management of patients in whom MitraClip treatment is being contemplated.
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