title: Community-acquired adult Escherichia coli meningitis leading to diagnosis of unrecognized retropharyngeal abscess and cervical spondylodiscitis: a case report.
abstract: BACKGROUND
  Escherichia coli is a rare cause of community-acquired meningitis in adults unless predisposing factors are present (e.g., previous penetrating cranio-cerebral injury or neurosurgery, immunosuppression, chronic alcoholism, history of cancer, diabetes mellitus, advanced age).
  
  
  METHODS
  We describe the case of a 53-year-old woman, resident in Germany, suffering from community-acquired bacterial meningitis caused by CTX-M-9 type extended spectrum β-lactamase producing Escherichia coli. Because typical predisposing factors were not apparent, pathogen identification resulted in expanded diagnostics to exclude a distant or contiguous primary focus. By magnetic resonance tomography, a previously unrecognized large retropharyngeal abscess with cervical spondylodiscitis was detected. In retrospect, the patient had complained about neck pain for a few weeks prior to meningitis onset, but the symptoms were interpreted as being related to a herniated disk. Meningitis and osteomyelitis resolved completely under surgical treatment and meropenem therapy.
  
  
  CONCLUSIONS
  In case of adult Escherichia coli meningitis, underlying diseases should always be carefully excluded, especially if predisposing factors are not apparent.
authors.affiliation: Department of Medical Microbiology, Ruhr-University Bochum, Universitaetsstrasse 150, 44801, Bochum, Germany. rebekka.kohlmann@rub.de.|Institute of Medical Laboratory Diagnostics (IML) Bochum GmbH, Castroper Strasse 45, 44791, Bochum, Germany. rebekka.kohlmann@rub.de.
authors.forename: Rebekka
authors.initials: R
authors.lastname: Kohlmann
authors.affiliation: Department of Neurology, Evangelisches Krankenhaus Castrop-Rauxel, Grutholzallee 21, 44577, Castrop-Rauxel, Germany. a.nefedev@evk-castrop-rauxel.de.
authors.forename: Andrey
authors.initials: A
authors.lastname: Nefedev
authors.affiliation: Department of Medical Microbiology, Ruhr-University Bochum, Universitaetsstrasse 150, 44801, Bochum, Germany. martin.kaase@rub.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Kaase
authors.affiliation: Department of Medical Microbiology, Ruhr-University Bochum, Universitaetsstrasse 150, 44801, Bochum, Germany. soeren.gatermann@rub.de.|Institute of Medical Laboratory Diagnostics (IML) Bochum GmbH, Castroper Strasse 45, 44791, Bochum, Germany. soeren.gatermann@rub.de.
authors.forename: Sören G
authors.initials: SG
authors.lastname: Gatermann
mesh_terms: D015299:Discitis / Q000175:diagnosis* / Q000382:microbiology / Q000601:surgery; D004926:Escherichia coli / Q000201:enzymology / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000175:diagnosis* / Q000382:microbiology; D029968:Escherichia coli Proteins / Q000378:metabolism; D005260:Female; D005858:Germany; D006801:Humans; D008279:Magnetic Resonance Imaging; D020814:Meningitis, Escherichia coli / Q000175:diagnosis* / Q000382:microbiology / Q000601:surgery; D000077731:Meropenem; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis / Q000601:surgery; D017703:Retropharyngeal Abscess / Q000175:diagnosis* / Q000382:microbiology / Q000601:surgery; D013845:Thienamycins; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D029968:Escherichia coli Proteins; D013845:Thienamycins; C412613:CTX-M-9 protein, E coli; D001618:beta-Lactamases; D000077731:Meropenem