Ventriculitismeningitis

Ventriculitis-meningitis refers to infection that simultaneously involves the ventricular system of the brain and the meninges. It is most often encountered in hospitalized patients, especially after neurosurgical procedures or in association with intraventricular devices such as external ventricular drains or shunts. The condition can be caused by bacteria, fungi, or, less commonly, viruses, with bacteria being the most frequent cause in the post-surgical setting.

Common pathogens include Staphylococcus aureus, coagulase-negative staphylococci, enteric Gram-negative bacilli, and enteric Gram-positive organisms. Fungal infections, notably Candida species, can occur in immunocompromised individuals. Risk factors include neurosurgical intervention, CNS trauma, indwelling intraventricular devices, prior CNS infection, and immune suppression.

Clinical presentation can overlap with meningitis and ventriculitis alone. Patients may have fever, headache, nausea, altered mental status, and neck stiffness, but signs can be subtle in those with brain injury or sedation. Increased intracranial pressure and hydrocephalus may occur. In patients with ventriculostomy, catheter malfunction or drainage issues can also hint at infection.

Diagnosis relies on cerebrospinal fluid analysis obtained by lumbar puncture or intraventricular sampling. CSF typically shows pleocytosis with neutrophilic predominance, elevated protein, and reduced glucose, but findings can vary. Gram stain and culture guide therapy. Neuroimaging (MRI preferred) may reveal ependymal enhancement, periventricular signal changes, or hydrocephalus.

Treatment involves prompt broad-spectrum IV antibiotics with good central nervous system penetration, tailored to culture results. Common regimens include vancomycin plus an anti-pseudomonal agent; intraventricular antibiotics may be considered for persistent infection or retained devices. Infected neurosurgical devices should be removed or replaced when feasible. The duration is typically several weeks and depends on the pathogen and clinical response. Prognosis varies with underlying condition and promptness of treatment.