Open Access Highly Accessed Case report

Enterococcal meningitis caused by Enterococcus casseliflavus. First case report

Chiara Iaria1, Giovanna Stassi2, Gaetano Bruno Costa2, Rita Di Leo3, Antonio Toscano3 and Antonio Cascio4*

Author Affiliations

1 AILMI (Associazione Italiana per la Lotta contro le Malattie Infettive), Università di Messina, Italy

2 Servizio di Microbiologia, Università di Messina, Italy

3 Dipartimento di Neuroscienze, Università di Messina, Italy

4 Scuola di Specializzazione in Malattie Infettive, Dipartimento di Patologia Umana, Università di Messina, Italy

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BMC Infectious Diseases 2005, 5:3  doi:10.1186/1471-2334-5-3

Published: 14 January 2005



Enterococcal meningitis is an uncommon disease usually caused by Enterococcus faecalis and Enterococcus faecium and is associated with a high mortality rate. Enterococcus casseliflavus has been implicated in a wide variety of infections in humans, but never in meningitis.

Case presentation

A 77-year-old Italian female presented for evaluation of fever, stupor, diarrhea and vomiting of 3 days duration. There was no history of head injury nor of previous surgical procedures. She had been suffering from rheumatoid arthritis for 30 years, for which she was being treated with steroids and methotrexate. On admission, she was febrile, alert but not oriented to time and place. Her neck was stiff, and she had a positive Kernig's sign. The patient's cerebrospinal fluid was opalescent with a glucose concentration of 14 mg/dl, a protein level of 472 mg/dl, and a white cell count of 200/μL with 95% polymorphonuclear leukocytes and 5% lymphocytes. Gram staining of CSF revealed no organisms, culture yielded E. casseliflavus. The patient was successfully treated with meropenem and ampicillin-sulbactam.


E. casseliflavus can be inserted among the etiologic agents of meningitis. Awareness of infection of central nervous system with Enterococcus species that possess an intrinsic vancomycin resistance should be increased.