Primary pyogenic ventriculitis caused by Neisseria meningitidis: case report and review of the literature

Abstract

Background. Pyogenic ventriculitis is a well-known complication of meningitis, brain abscesses and intraventricular drains. Primary pyogenic ventriculitis is a rare entity and few cases have been described so far. We report the first case of primary pyogenic ventriculitis in an adult caused by Neisseria meningitidis and present an overview of all reported adult primary pyogenic ventriculitis cases in the English literature.Methods. A PubMed search was performed using the terms ependymitis, ventricular empyema, pyocephalus and ventriculitis. Filter was set for adults and English. Articles in which pyogenic ventriculitis was a complication of well-known risk factors were excluded. A total of five cases of primary pyogenic ventriculitis were identified.Results. There were seven adult patients. Only one patient showed signs of meningeal irritation. Four patients had positive blood cultures with Escherichia coli (one patient), methicillin-resistant Staphylococcus aureus (one patient), one patient was bacteraemic with Enterococcus faecalis, Escherichia coli and Peptostreptococcus spp., and N. meningitidis (our patient). In four patients cerebrospinal fluid was sent for culture, which yielded methicillin-sensitive Staphylococcus aureus (one patient), Peptostreptococcus spp. (one patient), Streptococcus intermedius (one patient, identified via 16S PCR) and Listeria monocytogenes (one patient). Cerebrospinal fluid cell count was determined in four patients and showed pleocytosis in all four cases. Ventricular drainage was performed in four patients. Five patients survived.Discussion. We report the first case of pyogenic ventriculitis caused by N. meningitidis. Primary pyogenic ventriculitis is a rare entity with various clinical presentations caused by various bacterial species. Treatment consists of adequate antimicrobial therapy, and ventricular drainage may be necessary.

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].…”

“…Pyogenic ventriculitis is a known complication of meningitis and especially following neurosurgical interventions (e.g. shunts), trauma or CSF leak [3,5]. Spontaneous, community-acquired gram-negative bacilli CNS infections are reported as rare, representing 8.7% of all cases of meningitis.…”

“…There are no specific recommendations for the management of patients with community-acquired ventriculitis [2,5]. An early neurosurgical opinion should be sought; however, the optimal duration for antimicrobial treatment is not well defined [2,3]. Given the potential high mortality and morbidity, longer duration of antibiotics should be considered (6-12 weeks) [2,5].…”

“…Pyogenic ventriculitis is defined as the presence of suppurative fluid in the cerebral ventricular system [1,2]. It is usually a complication of neurosurgical procedures, ruptured brain abscesses, or head injury [1][2][3]. Cases of community-acquired ventriculitis are rare, with only a few cases due to Escherichia coli (E. coli) reported in the literature [2,3].…”

“…It is usually a complication of neurosurgical procedures, ruptured brain abscesses, or head injury [1][2][3]. Cases of community-acquired ventriculitis are rare, with only a few cases due to Escherichia coli (E. coli) reported in the literature [2,3]. Bacteria can cause an acute septic process in the brain and the surrounding meninges, leading to cerebral vasculitis [4].…”