Sepsis, meningitis and cerebral abscesses caused by Citrobacter koseri.
After a 36-week diamniotic dichorionic gestation, an infant was delivered by elective caesarean section due to growth restriction and altered diastolic flow in the umbilical artery. Birth weight was 2140 g. The patient was admitted for exclusive parenteral nutrition, with umbilical venous catheter placement. Sinus tachycardia and temperature instability with positive inflammatory markers occurred at 51 h. Penicillin and gentamicin were started, but 6 h later septic shock with disseminated intravascular coagulation was noted. Vancomycin and meropenem were started and penicillin suspended. Citrobacter koseri was isolated from blood culture. Generalised clonic convulsions occurred on day 4, and an electroencephalogram revealed severe encephalic dysfunction. Cerebrospinal fluid cytochemical analysis was suggestive of meningitis, although culture was negative. Cefotaxime was added to the drug regimen. Cranioencephalic MR showed a temporal abscess and diffuse hemispheric destruction, with no indications for neurosurgery. After 6 weeks of therapy, neuroimaging follow-up showed multiloculated cystic encephalomalacia. Currently, the patient is 14 months old with axial hypotonia and decreased movements. The source of infection has not been determined. Nosocomial infection cannot be excluded and vertical transmission is unlikely.
Paediatric Department, Professor Doutor Fernando Fonseca Hospital, EPE, Lisbon, Portugal. claravazmarecos@gmail.com
Clara
C
Vaz Marecos
Marta
M
Ferreira
Maria Manuela
MM
Ferreira
Maria Rosalina
MR
Barroso
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001922:Brain Abscess / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology*; D002585:Cesarean Section; D041041:Citrobacter koseri / Q000302:isolation & purification*; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D004569:Electroencephalography; D004756:Enterobacteriaceae Infections / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008279:Magnetic Resonance Imaging; D016920:Meningitis, Bacterial / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology*; D011247:Pregnancy; D011272:Pregnancy, Multiple; D018805:Sepsis / Q000175:diagnosis* / Q000188:drug therapy* / Q000382:microbiology*; D016216:Ultrasonography, Prenatal
D000900:Anti-Bacterial Agents