Bacteroides fragilis ventriculitis and meningitis. Report of two cases
W. E. Feldman
Two patients with Bacteroides fragilis meningitis and ventriculitis were
treated. In one infant infection developed at 2 1/2 months of age as a
result of an infected ventriculoatrial shunt inserted to treat
hydrocephalus. In the second patient ventriculitis and meningitis developed
at 20 days of age, while he was convalescing from surgery for gastric
perforation that had occurred at 5 days of age. Both patients were treated
with ampicillin, chloramphenicol, and clindamycin, which sterilized the
blood and lumbar cerebrospinal fluid but not the ventricular cerebrospinal
fluid. The first patient received no further antibiotic therapy and died at
5 months of age. Metronidazole therapy sterilized the ventricular fluid of
the second patient, who survived the infection. Ventriculitis should be
suspected in patients with B fragilis meningitis. A brain scan should be
done to detect signs of ventriculitis or brain abscess. Metronidazole may
be the drug of choice in patients with B fragilis ventriculitis or
meningitis who do not respond to chloramphenicol.
