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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

Primary Pyogenic Ventriculitis in Adults: A Retrospective Case Series of Clinical Characteristics, Cerebrospinal Fluid Parameters, and Surgical Drain Managements

  • Yi-Jen Ho1,2
  • Hsiang-Ling Huang1,2,3
  • Po-Kai Wang4,5
  • Sheng-Tzung Tsai1,2,5
5 affiliations
  1. 1Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan
  2. 2Institute of Medical Sciences, Tzu Chi University, Hualien 970, Taiwan
  3. 3Department of Nursing, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan
  4. 4Department of Anesthesiology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan
  5. 5School of Medicine, Tzu Chi University, Hualien 970, Taiwan
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Abstract

Background/Objectives: Primary pyogenic ventriculitis in adults is a rare, life-threatening central nervous system infection occurring in the absence of prior neurosurgical interventions or indwelling medical devices. Due to its scarcity, individual clinical trajectories, cerebrospinal fluid (CSF) cytochemical variations, and external ventricular drain (EVD) management timing remain poorly defined. Methods: We conducted a retrospective case series of N = 8 with confirmed primary pyogenic ventriculitis admitted to a tertiary referral center in eastern Taiwan between 2019 and 2023. Individual-level clinical, neuroimaging, CSF, and surgical timing data were analyzed descriptively. Results: The cohort was 62.5% male (n = 5/8) with a median age of 60.5 years [IQR: 51.5–66.5]. All patients presented with severe initial neurological impairment (median initial Glasgow Coma Scale [GCS] = 7.5 [IQR: 4.0–9.75]). Overall 1-year mortality was 25.0% (n = 2/8, both male). Survivors (n = 6) exhibited marked initial CSF pleocytosis (median WBC = 1005.0 cells/µL [IQR: 508.0–1977.5]) and elevated protein (median = 1030.0 mg/dL [IQR: 847.5–1225.0]). Conversely, non-survivors (n = 2) demonstrated blunted initial CSF inflammatory markers (median WBC = 82.5 cells/µL; median protein = 212.1 mg/dL) alongside severe initial coma (median GCS = 3.5) and systemic shock requiring vasopressors. EVD placement occurred at a median of 2.5 days post-onset in non-survivors compared to 10.5 days in survivors, reflecting urgent, reactive surgical intervention in rapidly deteriorating cases (confounding by indication). At 1 year, surviving patients achieved a median modified Rankin Scale (mRS) score of 2.5 [IQR: 2.0–3.0]. Conclusions: In this rare adult primary pyogenic ventriculitis series, fatal cases were characterized by severe initial coma, vasopressor-dependent shock, and blunted CSF cellularity. Urgent EVD placement in non-survivors represented reactive rescue therapy. Future prospective multicenter registries are required to evaluate whether standardized, early intraventricular source control improves functional outcomes.

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Cite

BibTeXRIS
BibTeX
@article{ho2026primary,
  title = {{Primary Pyogenic Ventriculitis in Adults: A Retrospective Case Series of Clinical Characteristics, Cerebrospinal Fluid Parameters, and Surgical Drain Managements}},
  author = {Yi-Jen Ho and Hsiang-Ling Huang and Po-Kai Wang and Sheng-Tzung Tsai},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = oct,
  doi = {10.3390/jcm15207992},
  url = {https://www.mdpi.com/2077-0383/15/20/7992},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Primary Pyogenic Ventriculitis in Adults: A Retrospective Case Series of Clinical Characteristics, Cerebrospinal Fluid Parameters, and Surgical Drain Managements
AU  - Yi-Jen Ho
AU  - Hsiang-Ling Huang
AU  - Po-Kai Wang
AU  - Sheng-Tzung Tsai
PY  - 2026
DA  - 2026/10/01
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15207992
UR  - https://www.mdpi.com/2077-0383/15/20/7992
AB  - Background/Objectives: Primary pyogenic ventriculitis in adults is a rare, life-threatening central nervous system infection occurring in the absence of prior neurosurgical interventions or indwelling medical devices. Due to its scarcity, individual clinical trajectories, cerebrospinal fluid (CSF) cytochemical variations, and external ventricular drain (EVD) management timing remain poorly defined. Methods: We conducted a retrospective case series of N = 8 with confirmed primary pyogenic ventriculitis admitted to a tertiary referral center in eastern Taiwan between 2019 and 2023. Individual-level clinical, neuroimaging, CSF, and surgical timing data were analyzed descriptively. Results: The cohort was 62.5% male (n = 5/8) with a median age of 60.5 years [IQR: 51.5–66.5]. All patients presented with severe initial neurological impairment (median initial Glasgow Coma Scale [GCS] = 7.5 [IQR: 4.0–9.75]). Overall 1-year mortality was 25.0% (n = 2/8, both male). Survivors (n = 6) exhibited marked initial CSF pleocytosis (median WBC = 1005.0 cells/µL [IQR: 508.0–1977.5]) and elevated protein (median = 1030.0 mg/dL [IQR: 847.5–1225.0]). Conversely, non-survivors (n = 2) demonstrated blunted initial CSF inflammatory markers (median WBC = 82.5 cells/µL; median protein = 212.1 mg/dL) alongside severe initial coma (median GCS = 3.5) and systemic shock requiring vasopressors. EVD placement occurred at a median of 2.5 days post-onset in non-survivors compared to 10.5 days in survivors, reflecting urgent, reactive surgical intervention in rapidly deteriorating cases (confounding by indication). At 1 year, surviving patients achieved a median modified Rankin Scale (mRS) score of 2.5 [IQR: 2.0–3.0]. Conclusions: In this rare adult primary pyogenic ventriculitis series, fatal cases were characterized by severe initial coma, vasopressor-dependent shock, and blunted CSF cellularity. Urgent EVD placement in non-survivors represented reactive rescue therapy. Future prospective multicenter registries are required to evaluate whether standardized, early intraventricular source control improves functional outcomes.
SN  - 2077-0383
ER  -