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Case Reports: Reminder of important clinical lesson
Treatment of Capnocytophaga sputigena meningitis in a neurosurgical patient
  1. Terry John Evans1,
  2. Samitha Fernando1,
  3. Micaela Uberti2,
  4. Andrew J Martin2 and
  5. Marina Basarab1
  1. 1Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK
  2. 2Department of Neurosurgery, St George's University Hospitals NHS Foundation Trust, London, UK
  1. Correspondence to Dr Terry John Evans; john.evans17{at}nhs.net

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.

  • Meningitis
  • Neurosurgery
  • Infections

https://doi.org/10.1136/bcr-2022-249821

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    Footnotes

    • Contributors TJE and SF designed the project, and acquired and analysed the microbiological data, and drafted the manuscript—specifically the infection aspects. MU made a substantial contribution to the design of the work, interpreting and drafting the neurosurgical portions of the case. Andrew J Martin and MB played senior roles in guiding management of the patient, interpreting the data presented and revising the manuscript for intellectual content. All authors have approved the final version and agreed to be accountable for the accuracy of the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.