title: A case of meningitis due to Achromobacter xylosoxidans denitrificans 60 years after a cranial trauma.
abstract: BACKGROUND
  Achromobacter xylosoxidans (AX) is a non-fermentative aerobic gram-negative bacillus. It is an opportunistic pathogen and the causative agent of various infections. We report an original case of late posttraumatic meningitis due to AX denitrificans.
  
  
  METHODS
  An 83-year-old man was hospitalized for acute headache, nausea and vomiting. The emergency brain computer tomography (CT) scan did not reveal any anomaly. In his medical history, there was an auditory injury due to a cranial trauma incurred in a skiing accident 60 years earlier. Cytobiochemical analysis of the cerebrospinal fluid (CSF) revealed increased levels of neutrophils and proteins. The CSF bacterial culture was positive: the Gram stain showed a gram-negative bacillus, oxidase + and catalase +, and the biochemical pattern using the API 20 NE strip revealed AX dentrificans. Late posttraumatic meningitis on a possible osteomeningeal breach was diagnosed even though the breach was not confirmed because the patient declined a second brain CT scan. The patient was successfully treated with meropenem.
  
  
  CONCLUSIONS
  This report demonstrates the importance of searching for unusual or atypical organisms when the clinician encounters meningitis in a particular context, as well as the importance of adequate follow-up of craniofacial traumas.
authors.affiliation: Department of Geriatrics and Internal Medicine, Hospital of Champmaillot, University Hospital, Dijon, France. patrick.manckoundia@chu-dijon.fr
authors.forename: Patrick
authors.initials: P
authors.lastname: Manckoundia
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Mazen
authors.forename: Alexis Saloff
authors.initials: AS
authors.lastname: Coste
authors.forename: Sophie
authors.initials: S
authors.lastname: Somana
authors.forename: Sophie
authors.initials: S
authors.lastname: Marilier
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Duez
authors.forename: Agnès
authors.initials: A
authors.lastname: Camus
authors.forename: Laura
authors.initials: L
authors.lastname: Popitean
authors.forename: Julien
authors.initials: J
authors.lastname: Bador
authors.forename: Pierre
authors.initials: P
authors.lastname: Pfitzenmeyer
mesh_terms: D042441:Achromobacter denitrificans / Q000502:physiology*; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D008581:Meningitis / Q000382:microbiology*; D012886:Skull / Q000473:pathology*; D014947:Wounds and Injuries / Q000473:pathology*