Primary pyogenic ventriculitis caused by Streptococcal pneumoniae in adults

Area of Science:

• Neurology
• Infectious Diseases
• Medical Microbiology

Background:

• Primary pyogenic ventriculitis is a rare complication of bacterial meningitis, predominantly seen in children.
• Adult cases of ventriculitis due to Streptococcus pneumoniae are infrequently reported, often attributed to vaccination and early antibiotic use.
• Ventriculitis typically necessitates prolonged antibiotic therapy and surgical intervention.

Observation:

• A 67-year-old diabetic female presented with decreased sensorium, seizures, and fever.
• Cerebrospinal fluid analysis indicated pyogenic meningitis, with Streptococcus pneumoniae identified in CSF and blood cultures.
• Magnetic Resonance Imaging (MRI) confirmed ventriculitis.

Findings:

• The patient received a 6-week course of Injection Ceftriaxazone.
• Serial MRI scans demonstrated resolution of ventricular debris.
• The patient experienced significant clinical improvement.

Implications:

• This case underscores the possibility of atypical presentations of pyogenic meningitis in adults, including the absence of nuchal rigidity and status epilepticus.
• Successful non-surgical management with antibiotics alone is feasible for ventriculitis in select adult cases.
• Highlights the importance of considering ventriculitis in adult patients with meningitis symptoms, even with atypical features.