Primary pyogenic ventriculitis caused by Neisseria meningitidis: case report and review of the literature

Abstract

<b>Background.</b> 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 by <i>Neisseria meningitidis</i> and present an overview of all reported adult primary pyogenic ventriculitis cases in the English literature. <b>Methods.</b> 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. <b>Results.</b> There were seven adult patients. Only one patient showed signs of meningeal irritation. Four patients had positive blood cultures with <i>Escherichia coli</i> (one patient), methicillin-resistant <i>Staphylococcus aureus</i> (one patient), one patient was bacteraemic with <i>Enterococcus faecalis</i>, <i>Escherichia coli</i> and <i>Peptostreptococcus</i> spp., and <i>N. meningitidis</i> (our patient). In four patients cerebrospinal fluid was sent for culture, which yielded methicillin-sensitive <i>Staphylococcus aureus</i> (one patient), <i>Peptostreptococcus</i> spp. (one patient), <i>Streptococcus intermedius</i> (one patient, identified via 16S PCR) and <i>Listeria monocytogenes</i> (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. <b>Discussion.</b> We report the first case of pyogenic ventriculitis caused by <i>N. meningitidis</i>. 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.