Meningorectal fistula as a cause of polymicrobial anaerobic meningitis.
A 49-year-old diabetic woman developed polymicrobial anaerobic meningitis secondary to a meningorectal fistula one year after receiving neutron beam therapy for a rectal adenocarcinoma. The meningitis was refractory to chloramphenicol and penicillin but responded to oral metronidazole. Sustained eradication of meningitis was achieved with continued metronidazole for 51/2 months, despite persistence of the fistula. Metronidazole may be a superior antimicrobial agent for polymicrobial anaerobic meningitis, especially when caused by a large or continuing bacterial inoculum. This meningorectal fistula is the first of its kind to our knowledge to be demonstrated by microbiologic, radiologic, and pathologic studies.
D005260:Female; D005402:Fistula / Q000150:complications*; D006801:Humans; D008578:Meninges; D008581:Meningitis / Q000188:drug therapy / Q000209:etiology* / Q000382:microbiology; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D011878:Radiotherapy / Q000009:adverse effects; D012003:Rectal Fistula / Q000150:complications*
D008795:Metronidazole