title: Primary pyogenic ventriculitis caused byNeisseria meningitidis: case report and review of the literature.
abstract: Background.Pyogenic ventriculitis is a well-known complication of meningitis, brain abscesses and intraventricular drains. Primary pyogenic ventriculitis is a rare entity and few cases have been described so far. We report the first case of primary pyogenic ventriculitis in an adult caused byNeisseria meningitidisand present an overview of all reported adult primary pyogenic ventriculitis cases in the English literature.Methods.A PubMed search was performed using the terms ependymitis, ventricular empyema, pyocephalus and ventriculitis. Filter was set for adults and English. Articles in which pyogenic ventriculitis was a complication of well-known risk factors were excluded. A total of five cases of primary pyogenic ventriculitis were identified.Results.There were seven adult patients. Only one patient showed signs of meningeal irritation. Four patients had positive blood cultures withEscherichia coli(one patient), methicillin-resistantStaphylococcus aureus(one patient), one patient was bacteraemic withEnterococcus faecalis,Escherichia coliandPeptostreptococcusspp., andN. meningitidis(our patient). In four patients cerebrospinal fluid was sent for culture, which yielded methicillin-sensitiveStaphylococcus aureus(one patient),Peptostreptococcusspp. (one patient),Streptococcus intermedius(one patient, identified via 16S PCR) andListeria monocytogenes(one patient). Cerebrospinal fluid cell count was determined in four patients and showed pleocytosis in all four cases. Ventricular drainage was performed in four patients. Five patients survived.Discussion.We report the first case of pyogenic ventriculitis caused byN. meningitidis. Primary pyogenic ventriculitis is a rare entity with various clinical presentations caused by various bacterial species. Treatment consists of adequate antimicrobial therapy, and ventricular drainage may be necessary.
authors.affiliation: University Hospital of South Manchester , Southmoor Rd, Wythenshawe, Manchester M23 9LT1 , UK.
authors.forename: Firza
authors.initials: F
authors.lastname: Gronthoud
authors.affiliation: University Hospital of South Manchester , Southmoor Rd, Wythenshawe, Manchester M23 9LT2 , UK.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Hassan
authors.affiliation: National Aspergillosis Centre, 2nd Floor, Education and Research Building Hospital , Manchester, Wythenshawe M23 9LT , UK.
authors.forename: Pippa
authors.initials: P
authors.lastname: Newton
keywords: antimicrobial treatment; drainage; headache; neurologic symptoms; pleocytosis; primary pyogenic ventriculitis