Introduction: Streptococcus agalactiae pioventriculitis is considered an infrequent complication of intracraneal infections in adults, it is secondary to meningitis. It is suspected in those who present a failure in the treatment for meningitis or in those who develop hydrocephalus. It is usually asymptomatic, so its adequate diagnosis improves prognosis. Computed tomography and MR imaging contribute to its recognition allowing the determination of optimal and timely treatment.
Methods: A 62 year-old patient diagnosed with BGN Bacteremia, bacteremic sepsis of meningeal focus due to Streptococcus agalactiae pioventriculitis, bilateral intrahospital pneumonia, anemia under study, infected diabetic foot, descompensated DMS2, recovered prerenal AKI, sequenced polio; enters by left foot injury that after supramaleolar amputation becomes septic and with commitment of the state of consciousness. For evidence in pioventriculo brain CT an external right ventricular shunt is installed and subsequent to the evolution with hydrocephalus a bilateral right ventricular shunt is performed.
Results: HC and CSF culture were found finding Streptoccocus agalactiae, HIV test with negative result. Spontaneous PNC is initiated by sensitivity, as there was no adequate response it is scaled to meropenem + vancomycin, then the change of meropenem by intratecal amikacin is performed, due to the presence of right pioventriculitis. After completing the 21-day outline, he develops left hydrocephalus forcing left PVV installation which is then withdrawn without complications.
Conclusions: Pioventriculitis is an infection that can be asymptomatic, lethal and persistent even after meningitis treatment. Early diagnosis is essential for treatment.
Patient Care: Knowing a management plan facilitates both diagnosis and choice of pharmacological plan for patients with Streptoccocus agalactiae pioventriculitis
Learning Objectives: - To propose a protocol for the managemet of patients with Streptoccocus agalatiae pioventriculitis.
- Report a rare case in adults.
References: 1. Blancas D, Santin M, Olmo M, Alcaide F, Carratala J, Gudiol F. Group B streptococcal disease in nonpregnant adults: incidence, clinical characteristics, and outcome. Eur J Clin Microbiol Infect Dis. 2004 Mar;23(3):168–73.
2. Domingo P, Barquet N, Alvarez M, Coll P, Nava J, Garau J. Group B streptococcal meningitis in adults: report of twelve cases and review. Clin Infect Dis. 1997 Nov;25(5):1180–7.
3. Farley MM, Harvey RC, Stull T, Smith JD, Schuchat A, Wenger JD, et al. A population-based assessment of invasive disease due to group B Streptococcus in nonpregnant adults. N Engl J Med. 1993 Jun;328(25):1807–11.
4. Fukui MB, Williams RL, Mudigonda S. CT and MR imaging features of pyogenic ventriculitis. AJNR Am J Neuroradiol. 2001 Sep;22(8):1510–6.
5. Skoff TH, Farley MM, Petit S, Craig AS, Schaffner W, Gershman K, et al. Increasing burden of invasive group B streptococcal disease in nonpregnant adults, 1990-2007. Clin Infect Dis. 2009 Jul;49(1):85–92.
6. Zangwill KM, Schuchat A, Wenger JD. Group B streptococcal disease in the United States, 1990: report from a multistate active surveillance system. MMWR CDC Surveill Summ Morb Mortal Wkly report CDC Surveill Summ. 1992 Nov;41(6):25–32.