Postoperative cerebrospinal fluid infection by Ralstonia mannitolilytica: Two case reports and a literature review

Abstract

Background: Ralstonia species are Gram-negative bacilli that are commonly found in moist environments, such as water and soil. They are opportunistic human pathogens, particularly found among immunocompromised patients, and are an infrequent cause of infection. The difficulty in correctly identifying and differentiating between Ralstonia species members using routine biochemical methods as well as their resistance to many classes of antibiotics poses a specific diagnostic and therapeutic challenge.

Case description: We report two cases from our neurosurgical unit complicated by postoperative cerebrospinal fluid infection caused by Ralstonia Mannitolilytica that posed a therapeutic challenge.

Conclusion: Our hypothesis is contaminated irrigation fluids might be a significant cause of post-operative meningitis and prolonged hospital stay.

Keywords: Cerebrospinal fluid (CSF) infection; Meningitis; Ralstonia mannitolilytica.

Figure 1:

Magnetic resonance imaging of the brain, T1-weighted gadolinium-enhanced. Sagittal view, showing hypothalamic/suprasellar cyst, measuring 2.2 × 2.3 × 3.2 cm in its maximum transverse, anteroposterior, and craniocaudal dimensions, respectively, with peripheral thin enhancement of the cyst and solid enhancement of the right inferolateral. HLP=head left posterior.

Figure 2:

(a and b) Abdominal computed tomography image on (a) axial view Red circle: subcutaneous collection at shunt entry site (b) coronal view showing small subcutaneous collection at shunt entry site in the abdominal cavity measuring 3.7 × 6.0 cm, associated with small intrapelvic collection in the left supravesicular space causing minimal mass effect to the left lateral urinary bladder wall measuring 4.1 × 5.3 cm. RA= Right anterior / LP = left posterior / H=head/ F=feet, red circle: intrapelvic collection in the left supravesicular space causing minimal mass effect.