<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...

CSF appearance	CSF results
	White cell count	14 10⁶/L
	Polymorphs	30%
	Lymphocytes	70%
Clear and colourless	Red blood cells	1 10⁶/L
	Protein	0.55g/L
	Glucose	4.1mmol/L
	Serum glucose	6.8mmol/L

CSF appearance	CSF results
	White cell count	15 680 10⁶/L
	Polymorphs	95%
	Lymphocytes	5%
Turbid	Red blood cells	220 10⁶/L
	Protein	4.26g/L
	Glucose	0.4mmol/L
	Serum glucose	7.0mmol/L

Test	Result	Normal range
White cell count	9.8 10⁹/L	4-11 10⁹/L
Neutrophils	8.8 10⁹/L	2-7.5 10⁹/L
Lymphocytes	0.2 10⁹/L	1-4 10⁹/L
Platelets	62 10⁹/L	135-450 10⁹/L
C-reactive protein	643mg/L	0-5 mg/L
Creatinine	232 μmol/L	45-84μmol/L
Urea	19.7mmol/L	2.5-7.8 mmol/L

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

Article Category: Case Report

Publié en ligne: 31 janv. 2020

Pages: 65 - 70

Reçu: 20 févr. 2019

Accepté: 17 janv. 2020

DOI: https://doi.org/10.2478/jccm-2020-0002

Mots clés
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.

Fig. 1

Fig. 2

Fig. 3

Fig. 4

Fig. 5

Fig. 6

LP results (day 11)

LP results (admission day)

Results of relevant blood tests (on admission day)

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

Article Category: Case Report

Publié en ligne: 31 janv. 2020

Pages: 65 - 70

Reçu: 20 févr. 2019

Accepté: 17 janv. 2020

DOI: https://doi.org/10.2478/jccm-2020-0002

Mots clésmeningitis, 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.

Fig. 1

Fig. 2

Fig. 3

Fig. 4

Fig. 5

Fig. 6

LP results (day 11)

LP results (admission day)

Results of relevant blood tests (on admission day)

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