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Fulminant postsurgical Bacillus cereus meningitis: case report
Abstract:
A 25-year-old woman presented with decreased level of consciousness, bilateral papilledema, and bitemporal hemianopsia. While receiving oxacillin prophylaxis, she underwent ventriculostomy and a transsphenoidal approach for the removal of a growth hormone- and prolactin-secreting adenoma of the pituitary. Within 4 days, fewer, symptoms of meningitis, and marked cerebrospinal fluid (CSF) pleocytosis developed, associated with many large Gram-positive rods in the CSF, subsequently identified as Bacillus cereus. This case emphasizes the potential for Bacillus species to cause serious disease following surgery, including meningitis after intracranial surgery. Meningitis may be severe, and organisms are often resistant to standard surgical prophylactic regimens, which might include penicillin or cephalosporin derivatives. Isolation of Bacillus species from the CSF requires evaluation; these organisms should not be dismissed as contaminants or "non-pathogens," particularly when isolated from CSF of patients who have recently undergone neurosurgical procedures.
Insights
A rare case of Bacillus cereus meningitis occurred in a patient after pituitary surgery. This highlights the importance of not dismissing Bacillus species as contaminants, especially after neurosurgery.
Area of Science:
- Neuroscience
- Infectious Diseases
- Microbiology
Background:
- Pituitary adenomas can present with visual disturbances and hormonal imbalances.
- Surgical intervention, such as transsphenoidal removal, is a common treatment for pituitary adenomas.
- Prophylactic antibiotics are standard practice to prevent surgical site infections.
Observation:
- A 25-year-old woman developed meningitis with cerebrospinal fluid (CSF) pleocytosis and Gram-positive rods post-pituitary surgery.
- The patient presented with decreased consciousness, papilledema, and bitemporal hemianopsia.
- The causative agent was identified as Bacillus cereus, despite oxacillin prophylaxis.
Findings:
- Bacillus cereus can cause severe meningitis, particularly following intracranial surgery.
- The isolated Bacillus species demonstrated resistance to standard prophylactic antibiotics like penicillin and cephalosporins.
- CSF pleocytosis and the presence of Gram-positive rods are key indicators of bacterial meningitis.
Implications:
- Bacillus species should be considered potential pathogens in post-neurosurgical meningitis.
- Standard antibiotic prophylaxis may not be effective against Bacillus species causing meningitis.
- Prompt identification and evaluation of Bacillus species in CSF are crucial, especially in neurosurgical patients.