Community-acquired Escherichia coli meningitis with ventriculitis in an adult—a rare case report

Abstract

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.

When a Stroke is not Just a Stroke: Escherichia coli Meningitis with Ventriculitis and Vasculitis: A Case Report

“…As clinical presentation can be non-specific, the diagnosis relies essentially on neuroimaging. The current patient did not present with neck stiffness, which is consistent with findings reported by Gronthoud et al (2017) [3] and Kasimahanti et al (2018) [6].…”

“…Recent case reports and reviews on primary ventriculitis question the true prevalence of the condition [2,6]. As clinical presentation can be non-specific, the diagnosis relies essentially on neuroimaging.…”

“…Mortality associated with E. coli central nervous system (CNS) infections is high (47%), and it can be greater than 85% when associated with specific risk factors [5]. The emergence of extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae also poses a significant challenge to the management of these cases [6,7].…”

Antibiotic Resistance among Iraqi LocalE. coliIsolates

“…Recent reports of E. coli strains producing CTX-M-type or TEM-type extended-spectrum β-lactamases create a challenge. E. coli meningitis follows a high degree of bacteremia and invasion of the blood-brain barrier [21,98].…”

“…Diabetes mellitus, alcoholism, cirrhosis, HIV infection and malignancies are some of the risk factors to develop E coli meningitis. A distant source is usually identified, either from the urinary or the digestive tract [19][20][21][22].…”