Abstract
BackgroundEnterococcal meningitis is an uncommon disease usually caused by Enterococcus faecalis and Enterococcus faecium and is associated with a high mortality rate. Enterococcus casseliflavus has been implicated in a wide variety of infections in humans, but never in meningitis.Case presentationA 77-year-old Italian female presented for evaluation of fever, stupor, diarrhea and vomiting of 3 days duration. There was no history of head injury nor of previous surgical procedures. She had been suffering from rheumatoid arthritis for 30 years, for which she was being treated with steroids and methotrexate. On admission, she was febrile, alert but not oriented to time and place. Her neck was stiff, and she had a positive Kernig's sign. The patient's cerebrospinal fluid was opalescent with a glucose concentration of 14 mg/dl, a protein level of 472 mg/dl, and a white cell count of 200/μL with 95% polymorphonuclear leukocytes and 5% lymphocytes. Gram staining of CSF revealed no organisms, culture yielded E. casseliflavus. The patient was successfully treated with meropenem and ampicillin-sulbactam.ConclusionsE. casseliflavus can be inserted among the etiologic agents of meningitis. Awareness of infection of central nervous system with Enterococcus species that possess an intrinsic vancomycin resistance should be increased.
Highlights
Enterococcal meningitis is an uncommon disease usually caused by Enterococcus faecalis and Enterococcus faecium and is associated with a high mortality rate
Enterococcal meningitis is an uncommon disease accounting for only 0.3% to 4% of cases of bacterial meningitis which is associated with a high mortality rate
It has been described most frequently in patients with neurosurgical conditions, it can occur as a "spontaneous" infection complicating remote enterococcal infections such as endocarditis or pyelonephritis [1]
Summary
Enterococcal meningitis is an uncommon disease accounting for only 0.3% to 4% of cases of bacterial meningitis which is associated with a high mortality rate It has been described most frequently in patients with neurosurgical conditions (i.e. head trauma, shunt devices, or cerebrospinal fluid leakage), it can occur as a "spontaneous" infection complicating remote enterococcal infections such as endocarditis or pyelonephritis [1]. BMC Infectious Diseases 2005, 5:3 http://www.biomedcentral.com/1471-2334/5/3 intrinsic low level resistance to vancomycin. It has been implicated in a wide variety of infections in humans, especially immunocompromised hosts, but to the best of our knowledge it has never been associated to meningitis [25]. E. casseliflavus and E. gallinarum are responsible for 1–2% of all enterococcal infections and are characterized by the fact that they possess intrinsic low-level vancomycin resistance [8]. Infection with E. gallinarum and E. casseliflavus has been associated with high mortality, but it is difficult to attribute their mortality directly to infection or to the underlying conditions of the patient
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