Clinical Challenge and Treatment Outcome for Primary Ventriculitis in Adults

Introduction: This retrospective study aimed to provide insights into the clinical presentation, microbiological aspects, imaging characteristics, and outcomes of idiopathic ventriculitis, a relatively underexplored entity within the spectrum of central nervous system (CNS) infections. We sought to better understand this condition's profile and identify factors contributing to adverse outcomes, particularly one-year mortality and long-term neurological sequelae, using a comprehensive definition that incorporates clinical, microbiological, and radiological criteria.

Methods: We conducted a retrospective analysis of patients with idiopathic ventriculitis admitted to a tertiary care hospital in Eastern Taiwan from 2019 to 2023. Eligible patients were adults (age ≥18 years) exhibiting clinical symptoms suggestive of ventriculitis, microbiological documentation through positive cerebrospinal fluid (CSF) and/or blood cultures, and radiological evidence indicative of ventriculitis. We excluded cases with recent neurosurgery, neurosurgical devices impacting CSF circulation, or traumatic CSF leaks. Clinical data, comorbidities, microbiological findings, imaging features, and outcomes (in-hospital mortality, one-year mortality, and neurological impairment) were collected and analyzed.

Results: Among the five patients included, common clinical manifestations were fever (80%), headache (60%), decreased consciousness (80%), and focal neurological signs (60%). Median CSF parameters included a white cell count of 302.8 cells/uL, predominantly polymorphonuclear (60%), glucose level of 0.7 mg/dL, and CSF protein level of 998.96 mg/dL. Intraventricular pus (80%) and ependymal enhancement (60%) were frequent radiological findings. Empirical antibiotic treatment was often employed due to challenges in pathogen identification. In-hospital mortality occurred in 20% of cases, with one-year mortality affecting one patient. Survivors frequently suffered long-term neurological sequelae, necessitating shunt implantation in 75% of cases.

Conclusion : This study underscores the complexity and challenges associated with idiopathic ventriculitis. Despite the absence of positive cultures, patients presented with distinctive clinical and radiological features, often leading to empiric antibiotic treatment. A considerable burden of long-term neurological impairment was observed among survivors, emphasizing the need for continued research and collaborative work between instituitions to enhance our understanding of this condition and optimize clinical management strategies.