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

Barbara Ribeiro

Barbara Ribeiro

Intensive Care Unit, Colchester General Hospital, East Suffolk and North Essex NHS Foundation TrustColchester, United Kingdom
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Ribeiro, Barbara
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Peter Bishop

Peter Bishop

Intensive Care Unit, Colchester General Hospital, East Suffolk and North Essex NHS Foundation TrustColchester, United Kingdom
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Bishop, Peter
 and 
Sima Jalili

Sima Jalili

Microbiology Department, Colchester General Hospital, East Suffolk and North Essex NHS Foundation TrustColchester, United Kingdom
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Jalili, Sima
  
Jan 31, 2020
When a Stroke is not Just a Stroke: Escherichia coli Meningitis with Ventriculitis and Vasculitis: A Case Report's Cover Image
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Article Category: Case Report
Published Online: Jan 31, 2020
Page range: 65 - 70
Received: Feb 20, 2019
Accepted: Jan 17, 2020
DOI: https://doi.org/10.2478/jccm-2020-0002
Keywords
© 2020 Barbara Ribeiro, Peter Bishop, Sima Jalili, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Introduction

Community-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 presentation

A 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.

Conclusion

Bacterial 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.

Language:
English
Publication timeframe:
4 times per year
Journal Subjects:
Medicine, Clinical Medicine, Anaesthesiology, Emergency Medicine and Intensive-Care Medicine, Internal Medicine, Internal Medicine, other, Surgery, Surgery, other
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