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Subdural empyema due to Enterococcus faecalis

B L Jones1, M H Wilcox

  • 1Clinical Microbiology and Public Health Laboratory, Addenbrooke's Hospital, Cambridge, UK.

Scandinavian Journal of Infectious Diseases
|January 1, 1997
PubMed
Summary
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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.

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  • 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.