Conspicuous endoscopic appearance of ventriculitis caused by coagulase-negative staphylococci.
To date, reports about the macroscopic appearance of ventriculitis have been rare, consisting only of a few autopsy cases. A patient in our hospital had ventriculitis caused by coagulase-negative staphylococci, and under neuroendoscopy we obtained clear findings of granular ependymitis. A 44-year-old man was admitted for disturbance of consciousness caused by progressive hydrocephalus. He had experienced subarachnoid hemorrhage (SAH) from a left vertebral dissecting aneurysm, and had subsequently received a ventriculoperitoneal shunt against post-SAH hydrocephalus. After admission, he was found to have retrograde shunt infection from peritonitis caused by cholecystitis. Coagulase-negative staphylococci were detected in cerebrospinal fluid (CSF), and the infection persisted even with intrathecal administration of gentamycin, and intravenous administration of vancomycin and arbekacin. Endoscopic rinsing was performed, and multiple small yellowish microgranulations, less than 1 mm in diameter, were observed in the lateral ventricles and the third ventricle. Rinsing of the CSF after intensive antimicrobial treatment resulted in a cure. Because there have been no reports of endoscopic observations of bacterial ventriculitis, we were unable to be certain about the origin or significance of the microgranulations. However, whether or not the microgranulations were bacterial colonies, infection did not recur during a 2-year follow-up period.
Chang
Chih-Wei
CW
Department of Neurosurgery, Fujigaoka Hospital, Showa University, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Kanagawa 227-8501, Japan.
Nagashima
Goro
G
Fujimoto
Tsukasa
T
Suzuki
Ryuta
R
Itokawa
Hiroshi
H
Endoh
Shu
S
Noda
Masayuki
M
Okuda
Muneo
M
D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002552:Cerebral Ventricles / Q000382:microbiology* / Q000473:pathology; D002764:Cholecystitis / Q000150:complications; D004660:Encephalitis / Q000175:diagnosis / Q000382:microbiology / Q000473:pathology; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D044583:Neuroendoscopy; D010538:Peritonitis / Q000150:complications; D013203:Staphylococcal Infections / Q000134:cerebrospinal fluid* / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology*; D013210:Staphylococcus / Q000145:classification / Q000187:drug effects / Q000201:enzymology / Q000472:pathogenicity; D013345:Subarachnoid Hemorrhage / Q000628:therapy; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*
D000900:Anti-Bacterial Agents