title: Unusual manifestation of Helicobacter cinaedi infection: a case report of intracranial subdural empyema and bacteremia.
abstract: There have been various reports concerning Helicobacter cinaedi infections. However, few reports have examined central nervous system infections.
  
  
  
  A 52-year-old man was transferred from the local hospital because of a persistent headache and suspected intracranial subdural empyema. Neurosurgical drainage was performed via burr holes. Gram staining and results from abscess cultures were negative. The blood culture yielded H. cinaedi. He was given an antibiotic regimen consisting of 2 g of ceftriaxone twice a day, but the size of the abscess was not reduced in size at all after 3 weeks of treatment. Neurosurgical drainage was performed again, and the antimicrobial regimen was switched to 2 g of meropenem 3 times a day. The size of the abscess was reduced after 2 weeks of the second drainage and antimicrobial drug change to meropenem. After 4 weeks treatment with meropenem, the patient was discharged, and his symptoms had completely resolved.
  
  
  
  H. cinaedi infection should be considered in the differential diagnosis of subdural empyema cases for which Gram staining and abscess culture results are negative. Meropenem can be a first-line drug of choice or an effective alternative treatment for H. cinaedi central nervous system infections.
authors.affiliation: Division of Infectious Diseases, Maebashi Red Cross Hospital, Asahicho 3-21-36, Maebashi, Gunma, 371-0014, Japan. t-hayashi@maebashi.jrc.or.jp.
authors.forename: Toshimasa
authors.identifier: 0000-0001-8803-0914
authors.initials: T
authors.lastname: Hayashi
authors.affiliation: Department of Microbiology, School of Pharmacy, Aichi Gakuin University, Nisshin, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Tomida
authors.affiliation: Department of Microbiology, School of Pharmacy, Aichi Gakuin University, Nisshin, Japan.
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kawamura
authors.affiliation: Division of Clinical Laboratory, Maebashi Red Cross Hospital, Maebashi, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yoshida
authors.affiliation: Division of Clinical Laboratory, Maebashi Red Cross Hospital, Maebashi, Japan.
authors.forename: Ikuyo
authors.initials: I
authors.lastname: Yokozawa
authors.affiliation: Division of Clinical Laboratory, Maebashi Red Cross Hospital, Maebashi, Japan.
authors.forename: Shingaku
authors.initials: S
authors.lastname: Kaneko
mesh_terms: D000038:Abscess / Q000188:drug therapy; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology; D002443:Ceftriaxone / Q000627:therapeutic use; D004322:Drainage; D013354:Empyema, Subdural / Q000188:drug therapy* / Q000382:microbiology; D016998:Helicobacter / Q000235:genetics / Q000472:pathogenicity; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology*; D006801:Humans; D008297:Male; D000077731:Meropenem; D008875:Middle Aged; D013845:Thienamycins / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D013845:Thienamycins; D002443:Ceftriaxone; D000077731:Meropenem
keywords: Antimicrobial susceptibility testing; Case report; Helicobacter cinaedi; Intracranial subdural empyema