Group D enterococcal meningitis. Clinical and therapeutic considerations with report of three cases and review of the literature

Bayer, Arnold S.; Seidel, James S.; Yoshikawa, Thomas T.; Anthony, Bascom F.; Guze, Lucien B.

doi:10.1001/archinte.136.8.883

Cited by 44 publications

(15 citation statements)

References 33 publications

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“…Most cases of enterococcal meningitis occur in patients with anatomic defects of CNS, prior neurosurgery, head trauma or immunosuppression 1,4,5,7 . Two presentations of enterococcal meningitis are usually described: postoperative and spontaneous.…”

Section: Discussionmentioning

confidence: 99%

Enterococcus gallinarum meningitis in an immunocompetent host: a case report

Antonello

Zenkner

França

2010

Rev. Inst. Med. trop. S. Paulo

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SUMMMARYWe describe a rare case of a 53-year-old man with a long history of alcohol abuse, with Enterococcus gallinarum meningitis, an organism that rarely causes human infection and is primarily found in the gastrointestinal tract of poultry. The patient improved with high-dose ampicillin and gentamicin therapy. To our knowledge, this is the first Brazilian reported case of E. gallinarum meningitis and probably the first case described in an immunocompetent host.

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Section: Discussionmentioning

confidence: 99%

Enterococcus gallinarum meningitis in an immunocompetent host: a case report

Antonello

Zenkner

França

2010

Rev. Inst. Med. trop. S. Paulo

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“…In case reports reviewed by Bayer et al, enterococcal meningitis was reported in one patient with meningeal leukemia who was receiving intrathecal chemotherapy, in two children with spina bifida, in one with meningomyelocoele, in one patient following a basilar skull fracture, and in one patient (who had recurrent enterococcal meningitis) with a communication between a mediastinal cyst and the spinal subarachnoid space (11). Of the three patients in this paper who were studied by the authors, one had meningomyelocoele and one was recovering from intracranial surgery for repair of an arteriovenous malformation; the third patient had no known central nervous system abnormality but had obstruction of the urinary tract due to prostatic cancer and an enterococcal UTI.…”

Section: Endocarditismentioning

confidence: 97%

“…Of the three patients in this paper who were studied by the authors, one had meningomyelocoele and one was recovering from intracranial surgery for repair of an arteriovenous malformation; the third patient had no known central nervous system abnormality but had obstruction of the urinary tract due to prostatic cancer and an enterococcal UTI. All three of these patients had CSF leukocyte counts of <50/mm3, and most of the patients reviewed had CSF leukocyte counts of <200/mm3 (11).…”

Section: Endocarditismentioning

confidence: 97%

“…Enterococcal pneumonia has also been seen following the use of polymyxin aerosol for prevention of Pseudomonas aeruginosa pneumonia; in addition to patients with pneumonia, 11 of 292 patients were colonized in the respiratory tract by enterococci (74). Enterococci were found in the urine of 8 of 45 patients (17.8%) treated with aztreonam; 7 of these had a Foley catheter and the eighth had a nephrostomy tube.…”

Section: Endocarditismentioning

confidence: 99%

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The life and times of the Enterococcus

Murray¹

1990

Clin Microbiol Rev

1,701

1,221

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Enterococci are important human pathogens that are increasingly resistant to antimicrobial agents. These organisms were previously considered part of the genus Streptococcus but have recently been reclassified into their own genus, called Enterococcus. To date, 12 species pathogenic for humans have been described, including the most common human isolates, Enterococcus faecalis and E. faecium. Enterococci cause between 5 and 15% of cases of endocarditis, which is best treated by the combination of a cell wall-active agent (such as penicillin or vancomycin, neither of which alone is usually bactericidal) and an aminoglycoside to which the organism is not highly resistant; this characteristically results in a synergistic bactericidal effect. High-level resistance (MIC, greater than or equal to 2,000 micrograms/ml) to the aminoglycoside eliminates the expected bactericidal effect, and such resistance has now been described for all aminoglycosides. Enterococci can also cause urinary tract infections; intraabdominal, pelvic, and wound infections; superinfections (particularly in patients receiving expanded-spectrum cephalosporins); and bacteremias (often together with other organisms). They are now the third most common organism seen in nosocomial infections. For most of these infections, single-drug therapy, most often with penicillin, ampicillin, or vancomycin, is adequate. Enterococci have a large number of both inherent and acquired resistance traits, including resistance to cephalosporins, clindamycin, tetracycline, and penicillinase-resistant penicillins such as oxacillin, among others. The most recent resistance traits reported are penicillinase resistance (apparently acquired from staphylococci) and vancomycin resistance, both of which can be transferred to other enterococci. It appears likely that we will soon be faced with increasing numbers of enterococci for which there is no adequate therapy.

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“…As discussed earlier, neonates are at risk for enterococcal sepsis and meningitis (68,69,81,82). Risk factors for meningitis have been identified as anatomical central nervous system defects or prior neurosurgical procedures such as shunt placement, especially if the shunt drains into the peritoneum (99, 100), Other risk factors include enterococcal UTI or endocarditis (99), however one recent case report described enterococcal meningitis in a man whose only predisposing factor was steroid therapy for chronic obstructive pulmonary disease (101). Enterococci are rarely implicated as the cause of lower respiratory tract infections.…”

Section: Other Miscellaneous Enterococcal Infectionsmentioning

confidence: 99%