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Subdural empyema due to Enterococcus faecalis
1Clinical Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Cambridge, UK.
Abstract:
Central nervous system infections due to Enterococcus species are uncommon. We report the first case of subdural empyema due to Enterococcus faecalis. Following partial treatment of a middle ear infection due to Enterococcus species and mixed coliforms, the patient developed signs of meningeal involvement. A lumbar puncture showed a raised polymorph cell count, but was sterile on culture; broad-spectrum antimicrobial therapy with cefotaxime, flucloxacillin and metronidazole was commenced. Following development of focal neurological signs, a CT scan revealed a subdural collection. Drainage and culture of the pus yielded a pure growth of Enterococcus faecalis. This case demonstrates the need to remain aware of the ability of the Enterococcus to cause serious infections and to direct specific antimicrobial therapy accordingly.
Insights
Central nervous system infections are rare. This case highlights Enterococcus faecalis causing subdural empyema, emphasizing targeted antimicrobial therapy for serious Enterococcus infections.
Area of Science:
- Infectious Diseases
- Neurology
- Microbiology
Background:
- Central nervous system (CNS) infections caused by Enterococcus species are infrequent.
- Enterococcus faecalis is a known pathogen, but typically associated with other types of infections.
Observation:
- A patient with a middle ear infection initially treated for Enterococcus species and mixed coliforms developed meningeal signs.
- Cerebrospinal fluid analysis showed inflammation but was sterile; initial broad-spectrum antibiotics were administered.
- Development of focal neurological deficits prompted a CT scan, revealing a subdural collection.
Findings:
- Surgical drainage and culture of the subdural collection yielded a pure growth of Enterococcus faecalis.
- This represents the first reported case of subdural empyema caused by Enterococcus faecalis.
- The case underscores the pathogen's potential to cause severe CNS infections.
Implications:
- Clinicians should consider Enterococcus species in the differential diagnosis of CNS infections, even when uncommon.
- Specific antimicrobial susceptibility testing is crucial for effective treatment of Enterococcus-related CNS infections.
- Awareness of Enterococcus faecalis's neuroinvasive potential is vital for prompt and appropriate patient management.