When a Stroke is not Just a Stroke: Escherichia coli Meningitis with Ventriculitis and Vasculitis: A Case Report

Abstract

IntroductionCommunity-acquired Escherichia coli ventriculitis is considered a rare condition. Central nervous system (CNS) infection due to gram-negative bacilli is usually associated with previous neurosurgical interventions. The recent publication of cases of Escherichia coli meningitis and ventriculitis suggests its prevalence may be underestimated by the literature.Case presentationA case of community-acquired Escherichia coli CNS infection on a 58 year old patient presenting with altered consciousness but without neck stiffness, nor significant past medical history is reported. Imaging and lumbar puncture findings suggested a complex case of meningitis with associated ventriculitis and vasculitis. Escherichia coli was later identified in cultures. Subsequent multi-organ support in Intensive Care was required. The patient was treated with a prolonged course of intravenous antimicrobials guided by microbiology, resulting in some neurological recovery. The main challenges encountered in the management of the patient were the lack of clear recommendations on the duration of treatment and the potential development of multi-resistant organisms.ConclusionBacterial central nervous system infections can have an atypical presentation, and an increasing number of cases of community-acquired ventriculitis have been reported. Early consideration should be given to use magnetic resonance imaging to help guide treatment. A long course of antibiotics is often required for these patients; however, the optimal duration for antimicrobial treatment is not well defined.

Pyogenic Ventriculitis Associated with Urosepsis: A Rare Case Report

“…In both these cases the initial diagnosis was urinary infection, but an altered mental status led to a subsequent study, with pyogenic ventriculitis being diagnosed. As in our case, E. coli was the bacterial agent implied as it grew on blood, urine and cerebrospinal fluid cultures [4,5] . We could only isolate E. coli in blood and urine cultures, probably because the patient was already on his fifth day of antibiotic, so we think it is reasonable to assume that the agent responsible for the pyogenic ventriculitis was E. coli.…”

“…We used an antibiotic regimen of ceftriaxone 2 g, 12/12h (the so called 'meningeal dose') for 6 weeks, even though there were no clinical guidelines to support it. In the two cases similar to ours, this was also the antibiotic regimen chosen, also with a good outcome [4,5]. The few cases published and the multitude of microorganisms implicated make it difficult to generate a universal recommendation, but the consensus seems to be to use long antibiotic regimens [1,6] .…”

“…The atypical clinical manifestations and variety of bacterial organisms involved make suspicion of pyogenic ventriculitis less likely. In a patient with an altered mental status, MRI is the most useful exam to diagnose this clinical condition as it shows specific abnormalities that cannot be differentiated in a CT scan [1][2][3]5] .…”

External ventriculostomy-associated infection reduction after updating a care bundle

“…According to Tunkel et al, no prophylactic EVD changes were made [ 1 ] in the absence of infection in this study. The updated care bundle considered the need for continuous reassessment of prolonged antibiotic treatment to prevent multi-resistance [ 36 , 37 ].…”

Unusual stroke mimic: a rare case of Escherichia coli meningitis

“…We found a single case report of spontaneous E. coli meningitis with ventriculitis from a urinary source. 5 Another case was reported, but had a CSF leak repair previously. 6 We hypothesise that the likely source in our patient was the urinary tract.…”