title: Meningitis related ventriculitis--experience from a tertiary care centre in northern India.
abstract: OBJECTIVE
  To assess clinical profile and short term outcome of patients with meningitis related ventriculitis.
  
  
  METHODS
  Case records of 47 patients admitted with a diagnosis of ventriculitis (complicating meningitis) over 3 y were analysed retrospectively.
  
  
  RESULTS
  The mean age of patients was 4.96 mo (20 d - 42 mo). The common symptoms were fever (27/47), enlarging head (23/47) and seizures (12/47) with signs of raised intracranial pressure (29/47). Ventricular cerebro-spinal fluid (CSF) showed mean cells - 237 cells/μL, sugar - 36 mg/dL and protein - 568 mg/dL. Gram stain and/or culture were positive in 5 patients. Ultrasonography of the head (done in 32 of 47 patients) showed hydrocephalus in 29 and internal echoes, debris or septations in ventricles in 5 patients. Computed tomography (CT) of brain (done in 42 of 47 patients) showed hydrocephalus in 36, abscesses in 7, ependymal enhancement in 4, infarcts in 4 and subdural empyema in 3 patients. MRI brain (done in 13 patients) showed hydrocephalus in all, 6 had cysts and 3 had ependymal enhancement. Thirty seven patients were started on ceftriaxone combined with vancomycin/cloxacillin with/without amikacin, and 10 patients received vancomycin and meropenem. Mean duration of antibiotics treatment was 4.17 wk (range; 0.8-12 wk). External ventricular drainage (EVD) was done in 22/47 patients. Cure rate (improvement in clinical and CSF parameters) in patients with external ventricular drainage was 59% as against 50% in patients who received antibiotics alone. At least 19 patients required ventriculoperitoneal (VP) shunt for unresolved significant hydrocephalus by discharge. There were 10 deaths, four of them occurred within first 2 wk of admission, one in 3rd wk and 5 within few months of discharge from hospital.
  
  
  CONCLUSIONS
  Ventriculitis associated with meningitis is a difficult to treat infection with significant mortality and morbidity. It requires prolonged administration of antibiotics. External ventricular drainage may improve cure rate and hasten clearing of CSF infection.
authors.affiliation: Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Kumar
authors.forename: Pratibha
authors.initials: P
authors.lastname: Singhi
authors.forename: Parag
authors.initials: P
authors.lastname: Dekate
authors.forename: Meenu
authors.initials: M
authors.lastname: Singh
authors.forename: Sunit
authors.initials: S
authors.lastname: Singhi
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000145:classification; D001431:Bacteriological Techniques / Q000379:methods; D058565:Cerebral Ventriculitis / Q000134:cerebrospinal fluid / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D002556:Cerebrospinal Fluid Proteins / Q000032:analysis; D002675:Child, Preschool; D004322:Drainage / Q000379:methods*; D005260:Female; D006257:Head / Q000000981:diagnostic imaging; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008581:Meningitis / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology; D014057:Tomography, X-Ray Computed / Q000379:methods; D017287:Ventriculoperitoneal Shunt / Q000379:methods / Q000706:statistics & numerical data
chemical_list: D000900:Anti-Bacterial Agents; D002556:Cerebrospinal Fluid Proteins