cefotaxime and Encephalitis

Defined by an infection of the ventricular system of the brain, ventriculitis is usually known as a health-care associated infection. In contrast, primary pyogenic ventriculitis complicating community-acquired meningitis is uncommon, and mainly described in infants. Only seven cases that have occured in adults have been found in the international literature.. We report here a new case due to Neisseria meningitidis occurring in an 85 year-old-man. The comparison with previous reports allows to drawn several conclusions: (i) cases occurred in relatively old adults (median age: 65 years); (ii) Streptococcus pneumoniae, N. meningitiditis and Staphylococcus aureus are the leading responsible pathogens; (iii) atypical clinical presentation seems the rule in which meningism often lacks; (iv) in absence of clinical or biological specific parameters, modern brain imaging such as magnetic resonance imaging with gadolinium enhancement is of utmost importance for the diagnosis, leading to anticipate an increase of the diagnosis in the near future, thanks to easier access to such exploration; (v) death or serious sequelae commonly occurred; (vi) prolonged antibiotic courses (6 weeks to 3 months) have been used, without strong rational. In the given case, the patient presented with a lack of meningeal irritation signs. The diagnosis was made by MRI considering a lasting confused state. A four-week antibiotic regimen was successful, combining two weeks of intravenous cefotaxime followed by two weeks of oral levofloxacin much easier to administrate and allowing early rehabilitation.. Primary bacterial ventriculitis is a real diagnosis challenge. Larger indications of MRI for bacterial meningitis, particularly in cases with an atypical presentation or poor evolution would certainly increase the number of diagnosis.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Brain; Cefotaxime; Cerebral Ventricles; Cerebral Ventriculitis; Communicable Disease Control; Encephalitis; Humans; Infectious Disease Medicine; Magnetic Resonance Imaging; Male; Meningitis, Bacterial; Middle Aged; Neisseria meningitidis; Staphylococcal Infections; Staphylococcus aureus; Streptococcus pneumoniae

Topics: Acyclovir; Anti-Bacterial Agents; Antiviral Agents; Brain Diseases; Cefotaxime; Corpus Callosum; Diagnosis, Differential; Encephalitis; Humans; Influenza, Human; Male; Middle Aged

Streptococcus intermedius is increasingly being recognised as an aetiological agent in central nervous system infections. Primary ventriculitis caused by this organism has not been reported so far. We present a case of primary ventriculitis, which resulted in adhesions and multiloculated hydrocephalus, necessitating numerous surgical procedures to control it. No predisposing factor(s) could be identified. Although the organism could not be cultured from CSF, as he was already on antibiotic treatment, it could, however, be identified by 16S rDNA polymerase chain reaction on the CSF sample. It appears important to recognise this condition and to treat it aggressively to prevent complications such as adhesions and multiloculated hydrocephalus.

Topics: Anti-Infective Agents; Cefotaxime; Cerebral Ventricles; Encephalitis; Endoscopy; Glasgow Coma Scale; Humans; Hydrocephalus; Male; Metronidazole; Middle Aged; Rifampin; Streptococcal Infections; Streptococcus intermedius; Tomography, X-Ray Computed

A 60-year old man developed a subacute psychoorganic syndrome over four weeks. CCT was normal, except a slight atrophy of the cerebellar superior vermiform process. In the CSF we found 1696/3 cells, suggesting a lesion of the hemato-encephalic barrier, an autochthonous IgG production and an increased specific antibody-titre (10.3) for Borrelia burgdorferi. Based on these data a Lyme-Neuroborreliosis being diagnosed. Treatment with Cefotaxim and Gentamycin was successful, a complete remission of the psychopathological symptoms had been obtained. This case is an uncommon manifestation of a Borrelia-burgdorferi-infection of the CNS with psychopathological symptoms but no neurological deficit. We conclude that an affection of the CNS with Borrelia burgdorferi must always be taken into consideration in patients presenting a subacute psychoorganic syndrome of unknown etiology.

Topics: Borrelia burgdorferi Group; Cefotaxime; Diagnosis, Differential; Drug Therapy, Combination; Encephalitis; Gentamicins; Humans; Lyme Disease; Male; Middle Aged; Neurocognitive Disorders; Neurologic Examination

A 6-week-old infant admitted to the University Hospital of the West Indies with hydrocephalus later developed ventriculitis. A heavy growth of Flavobacterium odoratum susceptible to gentamicin and cefotaxime was recovered from the ventricular fluid. Since intraventricular therapy was envisaged, a Pudenz reservoir was installed and ventricular fluid aspirated every 24 h to monitor treatment. Initial therapy consisted of intravenous cefotaxime, 50 mg/kg q.i.d. for 4 days. No significant reduction in the number of organisms in the ventricular fluid was achieved with this regimen. Intravenous therapy was therefore discontinued. On day 5 intraventricular therapy began with 5 mg cefotaxime 24 h for 6 days, followed by 1 mg/24 h for 4 days. Daily monitoring of intraventricular fluid indicated a high degree of antibacterial activity with rapid elimination of bacteria. Ventricular fluid remained sterile 10 days after therapy stopped. The Pudenz reservoir was removed, a ventriculoperitoneal shunt installed, and the patient discharged from hospital 4 days later without noticeable sequelae.

Topics: Bacterial Infections; Cefotaxime; Cerebral Ventricles; Cerebrospinal Fluid; Encephalitis; Flavobacterium; Humans; Infant; Injections, Intraventricular; Male

Topics: Cefotaxime; Ceftriaxone; Cerebral Ventricles; Child; Child, Preschool; Encephalitis; Humans; Infant; Infant, Newborn; Kinetics; Meningitis

Topics: Amikacin; Cefotaxime; Ceftriaxone; Cerebral Ventricles; Cerebrospinal Fluid Shunts; Drug Therapy, Combination; Encephalitis; Humans; Hydrocephalus; Injections, Intraventricular; Kanamycin

In three groups of patients levels of cefotaxime in serumand cerebrospinal fluid were determined. Therapeutic value and efficacy are discussed in meningitis patients. Nine concentrations of cefotaxime in lumbar and ventricular CSF out of 19 in a group of seven neurosurgical patients with mild to moderate impairment of the blood-CSF-barrier were higher than 0.5 micrograms/ml. In seven determinations in a second group of six patients with no or very little dysfunction of the blood-cerebrospinal-fluid barrier only twice cefotaxime was not detectable in lumbar CSF. Concentrations of cefotaxime in 25 determinations of lumbar or ventricular CSF in six patients with bacterial meningitis ranged from 1.1 micrograms/ml to 19.2 micrograms/ml. Treatment with cefotaxime alone was successful in a patient with E. coli meningitis and ventriculitis after infection of a ventriculo-atrial shunt and in another patient with pneumococcal meningitis and penicillin allergy. The other four patients with bacterial meningitis were treated successfully by antibiotics including cefotaxime.

Topics: Bacterial Infections; Blood-Brain Barrier; Cefotaxime; Cerebral Ventricles; Cerebrospinal Fluid Shunts; Encephalitis; Heart Atria; Humans; Meningitis