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Clinical and Therapeutic Considerations With Report of Three Cases and Review of the Literature

Arnold S. Bayer, MD; James S. Seidel, MD; Thomas T. Yoshikawa, MD; Bascom F. Anthony, MD; Lucien B. Guze, MD

Arch Intern Med. 1976;136(8):883-886.

Abstract
Three patients with meningitis due to the Lancefield group D enterococci are described and the pertinent literature is reviewed. Anatomic central nervous system (CNS) defects, prior neurologic or neurosurgical interventions, group D enterococcal endocarditis, and urinary tract infection appear to be important predisposing factors. Of note is the frequent lack of cellular response in the spinal fluid to enterococci. The mortality of this infection is high (33%) and is probably dictated as much by the underlying disorder as the infection itself.

The therapeutic importance of careful separation of group D streptococcal isolates into enterococci and nonenterococci, especially in instances of CNS infections, is emphasized. We discuss the appropriate antimicrobial therapy for enterococcal meningitis.

(Arch Intern Med 136:883-886, 1976)

Author Affiliations
From the departments of medicine (Drs Bayer, Yoshikawa, and Guze), and pediatrics (Drs Seidel and Anthony), Harbor General Hospital, Torrance, Calif; the departments of medicine (Drs Yoshikawa and Guze) and pediatrics (Dr Anthony), UCLA School of Medicine, Los Angeles; and the Research and Medical Services. Veterans Administration Hospital, Wadsworth Center, Los Angeles (Drs Bayer and Guze).

Footnotes
Received for publication Sept 16, 1975; accepted Dec 9, 1975.

Reprint requests to the Division of Infectious Diseases, Harbor General Hospital, 1000 W Carson St, Torrance, CA 90509 (Dr Bayer).

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