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Purulent meningitis caused by Actinomyces successfully treated with rifampicin: a case report

Keiko Imamura1, Hideki Kamitani, Hiroyuki Nakayasu

  • 1Department of Neurology, Tottori Prefectural Central Hospital, Japan. imamurakeiko@nifty.com

Internal Medicine (Tokyo, Japan)
|May 18, 2011
PubMed

Insights

A case of Actinomyces meningitis in a woman was treated with ampicillin and rifampicin. Rifampicin addition resolved persistent inflammation and granulation tissue, leading to complete recovery.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Microbiology

Background:

  • Actinomyces species are rare causes of meningitis, often presenting with non-specific symptoms like fever and headache.
  • Purulent meningitis due to Actinomyces requires effective antimicrobial therapy to prevent severe neurological sequelae.

Observation:

  • A 64-year-old woman presented with fever and headache, and cerebrospinal fluid (CSF) analysis revealed a high white blood cell (WBC) count and Actinomyces species.
  • Initial treatment with intravenous ampicillin controlled the infection but not the persistent CSF inflammation and subdural granulation tissue observed on MRI.

Findings:

  • Addition of rifampicin to ampicillin therapy led to normalization of CSF parameters.
  • A decrease in subdural granulation tissue enhancement was noted on lumbar MRI after rifampicin administration.
  • The patient achieved complete recovery 5 months after initiating combination therapy.

Implications:

  • Rifampicin may be a valuable adjunctive agent in treating meningitis caused by Actinomyces.
  • This case highlights the importance of considering Actinomyces in the differential diagnosis of purulent meningitis.
  • Further research is warranted to establish optimal treatment regimens for Actinomyces meningitis.

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