Group B streptococcal leptomeningitis, ventriculitis, right cerebellitis, and cerebritis in an immunocompetent patient

Abstract

Group B streptococcal (GBS) meningitis is uncommon in non-puerperal adults outside of significant immunocompromise or structural abnormalities. We describe a relatively healthy 62-year-old man with GBS bacteremia, abnormal lumbar puncture, and MRI-confirmed leptomeningitis, ventriculitis, right cerebellitis, and cerebritis who presented without overt symptoms of meningitis. The suspected source of infection was a high-inoculum genitourinary infection in the setting of hydronephrosis and recent cystoscopy. We performed a literature review of previous cases and clusters of GBS meningitis. With increasing recognition of invasive GBS infection among adult patients, and in light of our patient’s atypical presentation, we propose that an index of suspicion for GBS meningitis be maintained, even for patients who would traditionally have been considered at lower risk.

Community-Acquired Meningitis Complicated With Pyogenic Ventriculitis and Hydrocephalus in a Patient With Haematological Malignancy: A Case Report and Literature Review

“…However, studies have indicated that altered mental status, Kernig's sign, and Brudzinski's sign have limited diagnostic accuracy. Brouwer et al reported sensitivities of 31%, 11%, and 9%, respectively, and specificities of 71%, 95%, and 95%, respectively [ 8 ]. Therefore, a high degree of clinical suspicion must be supplemented with CSF analysis and imaging for a definitive diagnosis.…”

“…CSF analysis and culture remain the gold standard for diagnosing bacterial meningitis, with cultures yielding positive results in more than 80% of cases when obtained before treatment initiation [ 8 ]. Although performing a head CT before a lumbar puncture is often recommended to exclude signs and causes of elevated intracranial pressure (ICP), its necessity is subject to debate.…”

“…Due to a history of brain metastatic lesions, a head CT scan was warranted in our patient. Neuroradiological signs suggestive of elevated ICP include coning (herniation of cerebellar tonsils through the foramen magnum), effacement of basal cisterns, ventricles, and sulci, and the cerebellar reversal sign (a relatively enhanced appearance of the normal cerebellum compared to hypodense anoxic supratentorial brain) [ 8 , 10 ].…”

“…Although CSF culture is the standard for identifying causative organisms, nucleic acid amplification tests such as PCR have demonstrated higher sensitivity and specificity, exceeding 80% and 95%, respectively. These tests can also provide results within as little as two hours [ 4 , 8 ]. Kong et al reported that heparin-binding protein (HBP), released from activated neutrophils, displayed greater diagnostic accuracy compared to lactate and procalcitonin, with levels remaining elevated (greater than 23 ng/mL) even in patients treated with antimicrobials for more than 48 hours.…”