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Streptococcus intermedius causing primary bacterial ventriculitis in a patient with severe periodontitis - a case
Satu Allonen1, Janne Aittoniemi2, Matti Vuorialho3
1Mehiläinen, Tammisaari, Finland.
Background:
Streptococcus intermedius is a member of the S. anginosus group and is part of the normal oral microbiota. It can cause pyogenic infections in various organs, primarily in the head and neck area, including brain abscesses and meningitis. However, ventriculitis due to periodontitis has not been reported previously.
Case Presentation:
A 64-year-old male was admitted to the hospital with a headache, fever and later imbalance, blurred vision, and general slowness. Neurological examination revealed nuchal rigidity and general clumsiness. Meningitis was suspected, and the patient was treated with dexamethasone, ceftriaxone and acyclovir. A brain computer tomography (CT) scan was normal, and cerebrospinal fluid (CSF) Gram staining and bacterial cultures remained negative, so the antibacterial treatment was discontinued. Nine days after admission, the patient's condition deteriorated. The antibacterial treatment was restarted, and a brain magnetic resonance imaging revealed ventriculitis. A subsequent CT scan showed hydrocephalus, so a ventriculostomy was performed. In CSF Gram staining, chains of gram-positive cocci were observed. Bacterial cultures remained negative, but a bacterial PCR detected Streptococcus intermedius. An orthopantomography revealed advanced periodontal destruction in several teeth and periapical abscesses, which were subsequently operated on. The patient was discharged in good condition after one month.
Conclusions:
Poor dental health can lead to life-threatening infections in the central nervous system, even in a completely healthy individual. Primary bacterial ventriculitis is a diagnostic challenge, which may result in delayed treatment and increased mortality.
Insights
Poor dental health can cause serious Streptococcus intermedius infections in the brain, leading to ventriculitis. This case highlights the importance of oral hygiene in preventing life-threatening central nervous system infections.
Area of Science:
- Neurology
- Infectious Diseases
- Microbiology
Background:
- Streptococcus intermedius, part of the oral microbiota, can cause pyogenic infections.
- While known to cause brain abscesses and meningitis, ventriculitis from periodontitis is previously unreported.
Observation:
- A 64-year-old male presented with neurological symptoms including headache, fever, and imbalance.
- Initial meningitis treatment and diagnostics were inconclusive; condition worsened, revealing ventriculitis and hydrocephalus via MRI/CT.
- Advanced periodontal disease with abscesses was identified as the likely source.
Findings:
- Streptococcus intermedius was detected via PCR in cerebrospinal fluid (CSF) despite negative cultures.
- Gram-positive cocci were observed in CSF Gram staining.
- Advanced periodontal destruction and periapical abscesses were the probable origin of infection.
Implications:
- This case underscores the link between poor dental health and severe central nervous system infections.
- Primary bacterial ventriculitis presents diagnostic challenges, potentially delaying treatment and increasing mortality.
- Maintaining oral health is crucial for preventing potentially fatal infections.
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