ro13-9904 and Cerebral-Ventriculitis

Communicating hydrocephalus may complicate infantile bacterial meningitis, typically presenting with systemic features of infection. We report a rare case of 'subclinical meningoventriculitis' causing obstructive hydrocephalus and its challenging management. A healthy 10-week-old immunocompetent male patient presented with failure to thrive and vomiting, secondary to presumed gastro-oesophageal reflux. The child was neurologically alert, afebrile with normal inflammatory markers. Progressive macrocephaly prompted an MRI confirming triventricular hydrocephalus secondary to aqueductal stenosis. An endoscopic third ventriculostomy was performed however abandoned intraoperatively due to the unexpected finding of intraventricular purulent cerebrospinal fluid. A 6-week course of intravenous ceftriaxone was commenced for

Topics: Amoxicillin; Anti-Bacterial Agents; Ceftriaxone; Cerebral Ventriculitis; Cerebrospinal Fluid Shunts; Humans; Hydrocephalus; Infant, Newborn; Injections; Male; Meningoencephalitis; Polytetrafluoroethylene; Treatment Outcome; Ureter; Urinary Tract Infections; Ventriculostomy

A 64-year-old male came to our hospital emergency department with fever and consciousness disturbance. Culture tests of blood and spinal fluid samples revealed meningococci (Neisseria meningitidis), and we made a diagnosis of meningococcal meningitis. Brain magnetic resonance imaging (MRI) findings revealed ventriculitis. Ceftriaxone was administered for 17 days, however, relapse was noted after that was discontinued, with neutropenia and renal impairment thought to be adverse reactions to the beta-lactam antibiotic. Hence, treatment was switched to oral administration of moxifloxacin for a total of 12 weeks, including in an outpatient setting. After moxifloxacin was discontinued, no side effects or relapse were seen, and treatment was ended. Although antibacterial agents generally show favorable effects for meningococcal meningitis, we consider that sufficient antimicrobial therapy is difficult in cases complicated with ventriculitis.

Topics: Administration, Ophthalmic; Anti-Bacterial Agents; Ceftriaxone; Cerebral Ventriculitis; Drug Substitution; Fluoroquinolones; Humans; Magnetic Resonance Imaging; Male; Meningitis, Meningococcal; Middle Aged; Moxifloxacin; Recurrence; Treatment Outcome

Salmonella sp are important causes of meningitis among neonates and young children in Malaysia. We present a case of Salmonella enteritidis meningitis in a six week old female who presented with a one week history of fever, diarrhea and seizures which was unsuccessfully treated with a third generation cephalosporin. She had a relapse of meningitis complicated with ventriculitis and hydrocephalus, requiring an eleven week course of meropenem. She improved clinically, but did not have improvement in the cerebrospinal fluid (CSF) glucose level despite prolonged antibiotic use. This case illustrates the dilemma in determining the duration of antibiotic needed to successfully treat Salmonella enteritidis ventriculitis.

Topics: Anti-Bacterial Agents; Ceftriaxone; Cerebral Ventriculitis; Cerebrospinal Fluid; Female; Humans; Infant; Malaysia; Salmonella enteritidis; Salmonella Infections