Related Experiment Videos
Bacteroides fragilis ventriculitis and meningitis. Report of two cases
Insights
Bacteroides fragilis meningitis and ventriculitis are serious infections. Metronidazole effectively treated ventriculitis in one infant, highlighting its potential role in managing these challenging central nervous system infections.
Area of Science:
- Infectious Diseases
- Neurology
- Pediatrics
Background:
- Bacteroides fragilis is an opportunistic pathogen that can cause severe central nervous system infections, including meningitis and ventriculitis.
- Ventriculitis, an inflammation of the brain's ventricles, poses a significant challenge due to potential difficulties in antibiotic penetration.
- Hydrocephalus and post-surgical complications are risk factors for developing B. fragilis CNS infections.
Observation:
- Two infant patients presented with meningitis and ventriculitis caused by Bacteroides fragilis.
- Initial treatment with ampicillin, chloramphenicol, and clindamycin failed to eradicate the infection from the ventricular cerebrospinal fluid.
- One patient, treated with metronidazole, showed successful sterilization of ventricular fluid and survived.
Findings:
- Conventional antibiotic regimens may not effectively penetrate the ventricular cerebrospinal fluid to eliminate B. fragilis.
- Metronidazole demonstrated efficacy in sterilizing ventricular fluid in a patient with refractory B. fragilis ventriculitis.
- Prompt diagnosis and appropriate antimicrobial selection are crucial for favorable outcomes in B. fragilis CNS infections.
Implications:
- Ventriculitis should be strongly suspected in infants with B. fragilis meningitis, necessitating neuroimaging.
- Metronidazole should be considered a potential therapeutic option for B. fragilis ventriculitis, particularly in cases unresponsive to chloramphenicol.
- Further research is warranted to establish optimal treatment strategies for B. fragilis meningitis and ventriculitis.
Abstract:
Two patients with Bacteroides fragilis meningitis and ventriculitis were treated. In one infant infection developed at 2 1/2 months of age as a result of an infected ventriculoatrial shunt inserted to treat hydrocephalus. In the second patient ventriculitis and meningitis developed at 20 days of age, while he was convalescing from surgery for gastric perforation that had occurred at 5 days of age. Both patients were treated with ampicillin, chloramphenicol, and clindamycin, which sterilized the blood and lumbar cerebrospinal fluid but not the ventricular cerebrospinal fluid. The first patient received no further antibiotic therapy and died at 5 months of age. Metronidazole therapy sterilized the ventricular fluid of the second patient, who survived the infection. Ventriculitis should be suspected in patients with B fragilis meningitis. A brain scan should be done to detect signs of ventriculitis or brain abscess. Metronidazole may be the drug of choice in patients with B fragilis ventriculitis or meningitis who do not respond to chloramphenicol.