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Published on: July 9, 2012

Fatal meningitis caused by vancomycin-resistant enterococci: report of two cases from south India

I Praharaj1, S Sujatha, S C Parija

  • 1Department of Microbiology and Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India.

Indian Journal of Medical Microbiology
|June 6, 2012
PubMed

Insights

Vancomycin-resistant enterococci (VRE) rarely cause meningitis, posing a treatment challenge. This study reports two VRE meningitis cases in India, including a rare vanA gene in Enterococcus gallinarum.

Area of Science:

  • Infectious Diseases
  • Microbiology
  • Clinical Medicine

Background:

  • Vancomycin-resistant enterococci (VRE) are an emerging cause of hospital-acquired infections.
  • Enterococcal meningitis is rare and associated with high morbidity and mortality.
  • Therapeutic options for VRE infections are limited, necessitating a better understanding of resistance mechanisms.

Observation:

  • Two cases of enterococcal meningitis caused by VRE were identified.
  • Isolates were identified as Enterococcus faecalis and Enterococcus gallinarum.
  • Phenotypic and multiplex PCR methods were used for antimicrobial susceptibility testing and genetic analysis.

Findings:

  • The Enterococcus faecalis isolate exhibited vancomycin resistance.
  • The Enterococcus gallinarum isolate showed resistance to vancomycin and possessed both vanC1 and vanA resistance genes.
  • This is the first report of the vanA gene in Enterococcus gallinarum from the Indian subcontinent.
  • This study also marks the first reported case of VRE causing meningitis in India.

Implications:

  • The findings highlight the increasing threat of VRE meningitis, particularly in resource-limited settings.
  • The presence of vanA in Enterococcus gallinarum suggests potential for horizontal gene transfer and broader VRE dissemination.
  • This underscores the need for enhanced surveillance and development of novel therapeutic strategies against VRE infections.

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