<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_jccm-2020-0002_s_005_w2aab2b8c23b1b7b1aab1c16b1Aa"><h3>Introduction</h3><p>Community-acquired <italic>Escherichia coli</italic> 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 <italic>Escherichia coli</italic> meningitis and ventriculitis suggests its prevalence may be underestimated by the literature.</p></sec><sec id="j_jccm-2020-0002_s_006_w2aab2b8c23b1b7b1aab1c16b2Aa"><h3>Case presentation</h3><p>A case of community-acquired <italic>Escherichia coli</italic> 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. <italic>Escherichia coli</italic> 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.</p></sec><sec id="j_jccm-2020-0002_s_007_w2aab2b8c23b1b7b1aab1c16b3Aa"><h3>Conclusion</h3><p>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.</p></sec></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.

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

The Journal of Critical Care Medicine

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

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

IntroductionCommunity-acquired Escherichia coli ventriculitis is considered a rare condition. Central nervous system (CNS) infection due to gram-negative...

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

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
meningitis, ventriculitis, stroke, urinary tract infection, cerebral vasculitis, ceftriaxone

© 2020 Barbara Ribeiro, Peter Bishop, Sima Jalili, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

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

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

Keywordsmeningitis, ventriculitis, stroke, urinary tract infection, cerebral vasculitis, ceftriaxone

© 2020 Barbara Ribeiro, Peter Bishop, Sima Jalili, published by Sciendo

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Keywords
meningitis, ventriculitis, stroke, urinary tract infection, cerebral vasculitis, ceftriaxone