title: Enterococcal meningitis caused by Enterococcus casseliflavus. First case report.
abstract: BACKGROUND
  Enterococcal meningitis is an uncommon disease usually caused by Enterococcus faecalis and Enterococcus faecium and is associated with a high mortality rate. Enterococcus casseliflavus has been implicated in a wide variety of infections in humans, but never in meningitis.
  
  
  METHODS
  A 77-year-old Italian female presented for evaluation of fever, stupor, diarrhea and vomiting of 3 days duration. There was no history of head injury nor of previous surgical procedures. She had been suffering from rheumatoid arthritis for 30 years, for which she was being treated with steroids and methotrexate. On admission, she was febrile, alert but not oriented to time and place. Her neck was stiff, and she had a positive Kernig's sign. The patient's cerebrospinal fluid was opalescent with a glucose concentration of 14 mg/dl, a protein level of 472 mg/dl, and a white cell count of 200/muL with 95% polymorphonuclear leukocytes and 5% lymphocytes. Gram staining of CSF revealed no organisms, culture yielded E. casseliflavus. The patient was successfully treated with meropenem and ampicillin-sulbactam.
  
  
  CONCLUSIONS
  E. casseliflavus can be inserted among the etiologic agents of meningitis. Awareness of infection of central nervous system with Enterococcus species that possess an intrinsic vancomycin resistance should be increased.
authors.affiliation: AILMI (Associazione Italiana per la Lotta contro le Malattie Infettive), Università di Messina, Italy. iariachiara@libero.it
authors.forename: Chiara
authors.initials: C
authors.lastname: Iaria
authors.forename: Giovanna
authors.initials: G
authors.lastname: Stassi
authors.forename: Gaetano Bruno
authors.initials: GB
authors.lastname: Costa
authors.forename: Rita
authors.initials: R
authors.lastname: Di Leo
authors.forename: Antonio
authors.initials: A
authors.lastname: Toscano
authors.forename: Antonio
authors.initials: A
authors.lastname: Cascio
mesh_terms: D000368:Aged; D000667:Ampicillin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002555:Cerebrospinal Fluid / Q000382:microbiology*; D016983:Enterococcus / Q000187:drug effects / Q000302:isolation & purification*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology*; D006801:Humans; D016920:Meningitis, Bacterial / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology*; D000077731:Meropenem; D008826:Microbial Sensitivity Tests; D012810:Sigmoid Diseases / Q000150:complications*; D013407:Sulbactam / Q000008:administration & dosage; D013845:Thienamycins / Q000008:administration & dosage
chemical_list: D000900:Anti-Bacterial Agents; D013845:Thienamycins; C035444:sultamicillin; D000667:Ampicillin; D000077731:Meropenem; D013407:Sulbactam