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Pyogenic Ventriculitis Caused by Listeria Monocytogenes

Authors:
Fabrice Le Fevere De Ten Hove
Fabrice Le Fevere De Ten Hove
Fabrice Le Fevere De Ten Hove
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Thomas Reumont
Thomas Reumont
Thomas Reumont
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In case of meningitis, intraventricular sediments showing diffusion restriction on brain magnetic resonance imaging are highly suggestive of pyogenic ventriculitis for which early diagnosis is crucial for appropriate treatment.
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Case Report
A 78-year-old immunocompetent man presented to the
emergency room with high fever and acute confusional
state. Neurological examination was normal. Blood
analysis revealed markedly increased white blood cell
count (19.6 cells/nL [4.0–11.0]) and C-reactive protein
(223 mg/L [0.0–10.0]). Computed tomography (CT) of the
brain at the time of admission was normal, except for a
large left frontal sequela.
A few hours later, his condition deteriorated, with
onset of generalized seizures and loss of consciousness.
Meningitis was highly suspected and therefore, lumbar
puncture was performed. Cerebrospinal fluid (CSF) analysis
showed pleocytosis (2080 cells/mm³, 88% of polymorphs)
and increased protein levels (4.36 g/L [0.1–0.45]), which
confirmed the diagnosis of bacterial meningitis. Listeria
monocytogenes was cultured from the CSF and blood
samples, resulting in intravenous Amoxicillin treatment.
Due to the lack of clinical improvement, brain magnetic
resonance imaging (MRI) was performed and revealed
hyperintense debris in the occipital horns on diffusion-
weighted images (DWI, Figure 1A) with reduced apparent
diffusion coefficient (ADC, Figure 1B).
These ventricular sediments were slightly hypointense
on T2-weighted images (T2WI, Figure 2A) and on fluid-
attenuated inversion recovery (FLAIR, Figure 2B).
MRI showed a bright spot in the subarachnoid space of
the right parietal region on DWI (Figure 3B) appearing
slightly hypointense on FLAIR (Figure 3A).
There was no ependymal enhancement nor meningeal
thickening on gadolinium enhanced T1-weighted images.
Final diagnosis was pyogenic ventriculitis (PV) and
meningitis.
Le Fevere De Ten Hove F, Reumont T. Pyogenic Ventriculitis Caused by
Listeria Monocytogenes.
Journal of the Belgian Society of Radiology.
2020; 104(1): 13, 1–2. DOI: https://doi.org/10.5334/jbsr.2033
* Université Catholique de Louvain, BE
† Hôpital de Jolimont, BE
Corresponding author: Fabrice Le Fevere De Ten Hove
(Fabrice.lefevere@student.uclouvain.be)
IMAGES IN CLINICAL RADIOLOGY
Pyogenic Ventriculitis Caused by Listeria Monocytogenes
Fabrice Le Fevere De Ten Hove* and Thomas Reumont†
In case of meningitis, intraventricular sediments showing diusion restriction on brain magnetic resonance
imaging are highly suggestive of pyogenic ventriculitis for which early diagnosis is crucial for appropriate
treatment.
Keywords: Pyogenic ventriculitis; Ventricular empyema; Meningitis; Diusion restriction; Listeria
monocytogenes
Figure 1.
Figure 2.
Figure 3.
Le Fevere De Ten Hove and Reumont: Pyogenic Ventriculitis Caused
by Listeria Monocytogenes
Art. 13, page 2 of 2
How to cite this article: Le Fevere De Ten Hove F, Reumont T. Pyogenic Ventriculitis Caused by Listeria Monocytogenes.
Journal
of the Belgian Society of Radiology
. 2020; 104(1): 13, 1–2. DOI: https://doi.org/10.5334/jbsr.2033
Submitted: 21 December 2019 Accepted: 08 February 2020 Published: 06 March 2020
Copyright: © 2020 The Author(s). This is an open-access article distributed under the terms of the Creative Commons
Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium,
provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/.
OPEN ACCESS
Journal of the Belgian Society of Radiology
is a peer-reviewed open access journal
published by UbiquityPress.
Antimicrobial therapy was adjusted with combination
of Amoxicillin and Co-trimoxazol. Treatment lasted eight
weeks with good clinical evolution.
Comment
PV is a rare intracranial infection that mainly affects
children and immunocompromised patients. It is
characterized by existence of suppurative fluid in the
ventricles.
PV has also been described as ventricular empyema,
pyocephalus or pyogenic ependymitis.
Primary PV, although extremely rare, occurs after direct
hematogenous spread of bacteria to the choroid. PV is
more often secondary to extension of meningitis, rup-
ture of brain abscess, penetrating head injury or neuro-
surgery [1]. If not diagnosed and treated in time, it can
lead to severe neurological sequelae or even death. Signs
and symptoms are those of meningitis. Neuroimaging
techniques are mandatory for the diagnosis, especially
MRI, on which intraventricular sediments can be seen.
High viscosity of the purulent deposits decreases water
molecules mobility, which reduces ADC on DWI. Therefore
intraventricular sediments showing diffusion restriction
are highly suggestive of PV [1].
Hydrocephalus, ependymal enhancement, periven-
tricular and meningeal abnormalities are other findings
that may be helpful, but in our case, only ventricular
and meningeal purulent sediments were identified. CSF
analysis with isolation of the pathogenic agent is essential
in determining the antimicrobial therapy.
Competing Interests
The authors have no competing interests to declare.
Reference
1. Akhaddar A. Pyogenic Ventriculitis. Atlas of
Infections in Neurosurgery and Spinal Surgery,
Springer. 1st Ed. Springer International Publishing.
2017 Jul; 105–110. DOI: https://doi.org/10.1007/
978-3-319-60086-4_10
Pearls & Oy-sters: Diagnosis and Subtyping of Listeria Ventriculitis in an Immunocompetent Host
Article
  • May 2022
Listeria monocytogenes is a gram-positive food-borne pathogen that causes gastrointestinal symptoms and central nervous system (CNS) infection in susceptible hosts.. Two lineages of Listeria cause the majority of neurolisteriosis in humans. In this report, we discuss a case of a 23-year-old previously healthy female who presented with acute-onset rapidly progressive altered mental status after eating undercooked meats at a local restaurant. Given her age and lack of comorbidities, bacterial meningitis was suspected, and she was treated with ceftriaxone, vancomycin, and steroids. Magnetic resonance imaging of the brain was consistent with meningitis and ventriculitis; Cerebrospinal fluid (CSF) analysis also suggested bacterial meningitis. Despite mechanical ventilation, pressors, and ventricular drain placement, she quickly decompensated and died 12 hours after arrival. CSF culture later returned positive for Listeria monocytogenes . We used whole genome sequencing and near-source comparison to identify the Listeria subtype that led to her unexpected presentation. The results suggest that her CSF isolate was consistent with a lineage II Listeria serotype, which is known to exhibit greater genetic variation than the more commonly isolated lineage I serotypes. We conclude the discussion with diagnostic and treatment approaches to neurolisteriosis. In susceptible hosts, namely immunocompromised, pregnant, neonatal or elderly patients, Listeria infection may result in CNS invasion, causing meningoencephalitis and, rarely, ventriculitis and rhombencephalitis. Although neurolisteriosis most commonly affects individuals with known risk factors, CNS infection is nevertheless possible in otherwise healthy young patients. Suspicion should be raised in patients with an exposure history and do not improve with empiric antibiotics.
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Atlas of Infections in Neurosurgery and Spinal Surgery
Book
Full-text available
  • Aug 2017
This Atlas is the first reference Atlas covering exclusively all aspects of this multifaceted topic. It is designed to serve as a succinct appropriate resource for neurosurgeons, spinal surgeons, radiologists, neurologists, microbiologists, researchers and infectious disease specialists with an interest in cranio-cerebral and vertebro-medullary infections especially encountered in neurosurgery and spinal surgery. This Atlas is designed to deliver more information in less space than traditional texts, allowing for quick review of the essential facts of this complex infectious topic through pictures. Pertinent imaging and laboratory information are combined with intraoperative photographs and illustrations to help readers visualize variable presentations and enhance their perioperative management. The comprehensive content of this richly-illustrated book covers different infectious diseases seen on neurosurgical and spinal practices. The Atlas is divided into five sections, after a general introduction, the second section focuses on infections of the brain and its coverings. The third section focuses on vertebromedullary infections. The fourth section includes infections following cranial and spinal surgery, and the fifth section provides a description of the most important specific pathogens and other particular conditions. The format makes it easily accessible and includes a definition of each infection and its epidemiology, main clinical presentations, imaging features and laboratory findings, treatment options, and prognosis information. It will help the reader in choosing the most appropriate way to manage this multipart problem. In addition, the book supplies clinicians and investigators with both basic and more sophisticated information and procedures relating to the complications associated with neurosurgical and spinal infections.
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Pyogenic Ventriculitis
Chapter
  • Jul 2017
Pyogenic ventriculitis (pyoventriculitis) is characterized by the existence of suppurative fluid in the cerebral ventricular system. It may result from the rupture of a brain abscess, extension of meningitis into the ventricles, implantation of pathogens following a head injury, or a neurosurgical procedure with or without an implanted device. The typically indolent clinical course of pyoventriculitis sometimes can be rapidly life-threatening. Signs and symptoms are those of meningitis and raised intracranial pressure. Focal neurologic deficits may be present when a brain abscess is associated. Neuroimaging techniques are fundamental in the diagnosis. CT scan and especially MRI usually demonstrate intraventricular debris and pus in the cerebrospinal fluid (CSF). Other findings may include hydrocephalus, periventricular anomalies, and ventricular ependymal enhancement. CSF studies usually show a low glucose level, high protein, and pleocytosis. Isolation of the pathogenic agent and culture are essential in determining the antimicrobial therapy. When ventriculitis is unresponsive to intravenous antibiotics or if neurologic status is considered perilous, intrathecal antibiotic drugs can be administered. Concomitant brain abscess may be drained. Pyogenic ventriculitis is a potentially fatal infection that can lead to severe sequelae.
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