title: Meningitis due toMoraxella nonliquefaciensin a paediatric patient: a case report and review of the literature.
abstract: Introduction.Moraxella nonliquefaciensis an unusual organism to be isolated from cerebral spinal fluid (CSF) and there exists only one case report ofM. nonliquefaciensmeningitis from a neonate.Moraxellaspecies normally exist as part of the human upper respiratory tract flora and rarely cause invasive human disease. There are only a handful of case reports implicating the organism as a cause of endocarditis, bacteraemia, septic arthritis and endophthalmitis. Identification to the species level based on routine laboratory techniques has been challenging, with final identification often made through 16S rRNA sequencing. With the use of a newer diagnostic tool, matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) MS, we were able to rapidly identify the organism and initiate appropriate treatment.Case presentation.We present a rare care ofM. nonliquefaciensmeningitis in a paediatric patient with an underlying cranial anatomical defect due to Crouzon syndrome. She had been admitted to hospital 3 months previously withStreptococcus pneumoniaemeningitis and mastoiditis, and returned to the emergency department with meningismus. CSF culture grewM. nonliquefaciens. She was treated with ceftriaxone with rapid improvement and eventually was taken for endoscopic surgical repair of a right encephalocele defect.Conclusion.The use of MALDI-TOF MS allowed for the rapid identification of the organism. The patient recovered with appropriate antimicrobial therapy and eventual surgical correction. An underlying anatomical defect should be considered in all patients who present with meningitis due to this unusual organism.
authors.affiliation: Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine , 111 E 210th St, Bronx, NY 10467 , USA.
authors.forename: Carol
authors.initials: C
authors.lastname: Kao
authors.affiliation: Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine , 111 E 210th St, Bronx, NY 10467 , USA.
authors.forename: Wendy
authors.initials: W
authors.lastname: Szymczak
authors.affiliation: Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine , 111 E 210th St, Bronx, NY 10467 , USA.
authors.forename: Iona
authors.initials: I
authors.lastname: Munjal
keywords: Crouzon syndrome; Moraxella nonliquefaciens; meningitis; recurrent meningitis