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Meningitis caused by Oerskovia xanthineolytica
E J Kailath1, E Goldstein, F H Wagner
1Department of Internal Medicine, School of Medicine, University of California, Davis.
Abstract:
In summary, we describe a case of central nervous system infection with O. xanthineolytica in which the infecting microbe probably was engrafted on a ventricular shunt. The bacteria caused a smoldering meningitis that did not respond to penicillin and rifampin despite in vitro sensitivity, presumably because of inadequate cerebrospinal fluid penetration of the penicillin and the recognized difficulty of eradicating bacteria from contaminated shunts. Removal of the shunt and continued treatment with penicillin and rifampin resulted in cure.
Insights
A central nervous system infection caused by O. xanthineolytica, likely originating from a ventricular shunt, led to smoldering meningitis. Surgical removal of the shunt alongside antibiotic treatment successfully cured the infection.
Area of Science:
- Infectious Diseases
- Neuroscience
- Microbiology
Background:
- Ventricular shunts are crucial for managing cerebrospinal fluid (CSF) disorders but can be a nidus for infection.
- Central nervous system (CNS) infections pose significant diagnostic and therapeutic challenges.
Observation:
- A case of smoldering meningitis caused by Ochrobactrum xanthineolytica (O. xanthineolytica) is presented.
- The infection was likely introduced via a contaminated ventricular shunt.
- The meningitis exhibited resistance to standard antibiotic regimens, including penicillin and rifampin, despite in vitro susceptibility.
Findings:
- Inadequate penetration of penicillin into the cerebrospinal fluid was presumed to be a factor in treatment failure.
- The difficulty of eradicating bacteria colonizing shunt hardware complicates treatment.
- Combined surgical removal of the infected shunt and continued antibiotic therapy led to a complete cure.
Implications:
- This case highlights the importance of considering shunt-associated infections in CNS meningitis.
- It underscores the challenges in treating infections involving foreign bodies in the CNS.
- Successful management may require a multimodal approach, including device removal and targeted antimicrobial therapy.