Clostridium perfringens meningitis. Report of a case with neuropathological observations

Meningoencephalitis with subdural empyema caused by toxigenic Clostridium perfringens type A

We report a clinical case of meningoencephalitis with subdural empyema in an immunocompromised farmer caused by toxigenic Clostridium perfringens type A, which was identified by 16S RNA gene analysis of cerebrospinal fluid and subdural empyema. In immunocompromised patients, C. perfringens should be considered a potential pathogen of sepsis.

Clostridial brain abscesses

Ten patients with clostridial abscesses of the brain are presented. Despite the presence of gas within the cerebral hemispheres and Clostridium welchii cultured from the pus obtained, the outcome of all patients managed with burrhole aspiration of the abscess was good. There were no deaths and eight of the ten patients had no residual deficit. Clostridial infections of the brain, unlike those of the soft tissues of the body, have a good outcome with conservative surgery and appropriate antibiotics.

Meningitis and Brain Abscess Due to Clostridium Perfringens And Clostridium Paraputrificum Following Orbital Trauma

An 8 year old boy developed cerebral abscess and purulent meningitis due to Clostridium perfringens and Clostridium paraputrificum after trauma to the left orbit. The patient made a satisfactory recovery with surgical treatment and antibiotic therapy. A review of the literature revealed that meningitis due to Clostridia is rare and usually related to penetrating trauma, and that penetrating trauma to the orbit is associated with significant central nervous system morbidity.

Anaerobic bacterial meningitis

Anaerobic meningitis occurred in four patients in whom anaerobic bacteria had not been suspected as a possible cause. The predisposing conditions were typical of those seen in patients previously reported to have this infection and included chronic otitis media with mastoiditis, chronic sinusitis, recent craniotomy and abdominal trauma. Two of the patients had undergone immunosuppression (immunosuppressed patients); a compromised immune system may facilitate the development of anaerobic meningitis in patients with the appropritate underlying conditions. Head and neck neoplasms, head trauma, suppurative pharyngitis and laminectomy wounds are additional situations in which anaerobic meningitis occurs. Anaerobic bacterial meningitis probably occurs more often than is recognized. The cerebrospinal fluid should be transported and cultured anaerobically when meningitis develops in a patient with a predisposing condition.