Table 2.
Summary of Analyzed Streptococcus intermedius Meningitis/Ventriculitis Case Reports
| Clinical Profile | Symptoms | Imaging Results | CSF Analysis and Pathogen Identification | Diagnosis | Outcome |
|---|---|---|---|---|---|
| Case No1: 63-year-old healthy British male22 | Headache for 1 week, feeling intermittently hot and sweaty, and having clumsiness and unsteadiness, and diarrhea | Brain CT showed enlargement of the right lateral ventricle with increased density collection in the anterior horn and body of the right lateral ventricle, which suggests ventriculitis | CSF analysis: WBC:350 /μLwith 90% neutrophil; protein: 4466 mg/dL CSF culture negative. 16s rDNA PCR of CSF revealed positive for S. intermedius. |
S. intermedius ventriculitis | After 6-week cefotaxime administration and ventricular drainage, recovery with left-sided homonymous hemianopia remains. |
| Case No2: 6-year-old healthy Polish boy20 | Fever, headache, neck pain, right ear pain, and altered mental status | Brain CT showed thickened mucosa and foamy discharge in the right compartment of the sphenoid sinus as well as the single airless cells of the right mastoid process. | CSF analysis: WBC: 7197 /μL with 88% neutrophil; Protein: 130.4 mg/dL; Glucose: 2 mg/dL; Lactate: 11.1 mmol/L CSF culture: S. intermedius |
S. intermedius meningitis | Recovery after 14-day ceftriaxone administration. |
| Case No3: 62-year-old American male with history of hypertension, hyperlipidemia, previous ischemic stroke, and obstructive sleep apnea21 | Progressive vomiting, malaise, lightheadedness, headaches, acute onset disorientation, confusion, and eye rolling | Brain MRI showed diffuse ependymal enhancement that was not displayed throughout the ventricular system with debris present, which is most consistent with ventriculitis. | CSF analysis: WBC: 250,000 /μL; Protein: 1103 mg/dL; glucose: 6 mg/dL CSF culture: S. intermedius |
S. intermedius ventriculitis | After 4 dose of intrathecal vancomycin, 6-week ceftriaxone combined with ampicillin and ventricular drainage, recovery and kept rehabilitation. |
| Case No4: 64-year-old healthy Finnish male23 | Headache, fever, imbalance, blurred vision, and general slowness. | Brain MRI showed the ependyma of the right lateral ventricle and cavum septi pellucidi enhanced intensively— a sign of ventriculitis. | CSF analysis: WBC: 940 /μL; Protein: 1696 mg/dL; Glucose: 16.2 mg/dL CSF culture negative. 16s rRNA PCR of CSF revealed positive result of S. intermedius. |
S. intermedius ventriculitis | After 3-week antibiotic administration with caxone and following cefotaxime and ventricular drainage, recovery with slight left-sided hemiparesis. |
| Our case: 56-year-old Taiwanese male with history of hypertension and dyslipidemia | Headache, chills, nuchal rigidity, and nausea over 3 days | Brain MRI showed leptomeningeal enhancement in the bilateral cerebral sulci and brainstem surface, suggestive of meningitis and subependymal enhancement with sedimentation in the bilateral lateral ventricles | CSF analysis: WBC:1687 /μLwith 68% neutrophil; Protein: 772 mg/dL; Glucose: <10 mg/dL CSF culture negative. mNGS of CSF yielded S. intermedius. |
S. intermedius meningitis and ventriculitis | Recovery after antibiotic administration with 2-week ceftriaxone and Vancomycin following 4-week ceftriaxone, and underwent ventriculo-peritoneal shunt implementation |
Abbreviations: CSF, cerebrospinal fluid; CT, computed tomography; PCR, polymerase chain reaction; MRI, magnetic resonance imaging.