Treatment of Capnocytophaga sputigena meningitis in a neurosurgical patient.

Abstract

A woman in her 50s developed meningitis following an endoscopic, endonasal resection of a clival meningioma which was complicated by a cerebrospinal fluid (CSF) leak through the nose. CSF analysis showed a raised white cell count, and Capnocytophaga sputigena was isolated. This organism is an oral commensal and is implicated in periodontal disease; the CSF leak explains the portal of entry. C. sputigena is rarely isolated, and this is the first report of a central nervous system (CNS) infection caused by this organism. A worsening of our patient's dermatological condition, urticaria pigmentosa, coincided with empiric treatment with vancomycin and meropenem, which were therefore discontinued. Treatment was continued with chloramphenicol for 3 weeks, and the patient made a full recovery. Systemic chloramphenicol is uncommonly used in contemporary UK practice, but remains an excellent antibiotic for CNS penetration and it has excellent bioavailability. We anticipate increased chloramphenicol use as the number of multiresistant Gram-negative infection increases.

• Authors: Terry John Evans, Samitha Fernando, Micaela Uberti, Andrew J Martin, Marina Basarab
• Journal: BMJ case reports (BMJ Case Rep) Vol. 15 Issue 5 (May 25 2022) ISSN: 1757-790X [Electronic] England
• PMID: 35613833 (Publication Type: Case Reports, Journal Article)
• Copyright: © BMJ Publishing Group Limited 2022. No commercial re-use. See rights and permissions. Published by BMJ.

Chemical References

• Chloramphenicol

Topics

• Capnocytophaga
• Central Nervous System Infections (complications)
• Cerebrospinal Fluid Leak (etiology)
• Chloramphenicol
• Female
• Humans
• Meningeal Neoplasms (complications)
• Meningitis (complications, drug therapy)