Enterococcal Central Nervous System Infections in Children: A 22 Years' Experience in a Tertiary Center and Review of the Literature

Aviad Schnapp; Sergei Elber-Dorozko; Violeta Temper; Oren Gordon; Dina Averbuch

doi:10.1097/INF.0000000000004342

Enterococcal Central Nervous System Infections in Children: A 22 Years' Experience in a Tertiary Center and Review of the Literature

Pediatr Infect Dis J. 2024 Mar 26. doi: 10.1097/INF.0000000000004342. Online ahead of print.

Authors

Aviad Schnapp^{1

2}, Sergei Elber-Dorozko^{1

2}, Violeta Temper³, Oren Gordon^{1

2

4}, Dina Averbuch^{1

2

4}

Affiliations

¹ From the Department of Pediatrics, Faculty of Medicine, Hebrew University of Jerusalem.
² Pediatric Division, Department of Pediatrics, Hadassah Medical Center Jerusalem.
³ Department of Clinical Microbiology, Clinical Microbiology Laboratory.
⁴ Department of Clinical Microbiology, Pediatric Infectious Diseases Unit, Hadassah Medical Center, Jerusalem, Israel.

PMID: 38535091
DOI: 10.1097/INF.0000000000004342

Abstract

Background: Enterococcal meningitis in children is rare, and its clinical presentation, laboratory characteristics and outcomes are not well defined.

Methods: We conducted a retrospective analysis of Enterococcal meningitis cases during 2002-2023 at our tertiary center.

Results: We identified 10 cases in children aged 2 weeks to 15 years (median age: 8 months). Seven children were males and 9 had comorbidities, including a ventriculoperitoneal shunt in 5 children. All children with shunt infections presented with nonspecific signs and symptoms. While 8 children presented with fever, only 3 had signs of meningeal irritation and altered consciousness. Cerebrospinal fluid pleocytosis was evident in almost all children with a median of 173 cells/mL. Nine cases were due to Enterococcus faecalis, and 1 case was due to E. faecium. All 5 children with ventriculoperitoneal shunt underwent shunt removal and replacement. All children recovered without documented sequelae.

Conclusions: Enterococcal meningitis is rare, especially in healthy neonates. It typically occurs following neurosurgical interventions and may only present with fever and shunt malfunction, without overt meningeal signs and with mild inflammation. The prognosis is favorable.