Brain abscess by citrobacter diversus in infancy: case report

Feferbaum, Rubens; Diniz, Edna Maria Albuquerque; Valente, Mariana Lima da Costa; Giolo, Cláudia R.; Vieira, Ricardo P.; Galvani, Ana Lucia S; Ceccon, Maria Esther Jurfest Rivero; Araújo, Maria Christina Barbosa de; Krebs, Vera Lúcia Jornada; Vaz, Flávio A. C.

doi:10.1590/s0004-282x2000000400023

Cited by 10 publications

(9 citation statements)

References 8 publications

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“…Krebs et al 8 observed signifi cantly higher levels of IL-6 in the CSF of neonates with meningitis due to gram-negative bacteria, suggesting a higher intensity of the infl ammatory process in these newborns. The brain abscess, reported in literature in 1% of meningitis cases caused by gram-negative bacteria 17 , was observed in 3,4% of our patients. It is known that the abscess may have a slow evolution and reach great proportions until it is detected.…”

Section: Discussionmentioning

confidence: 46%

Clinical outcome of neonatal bacterial meningitis according to birth weight

Krebs¹,

Costa²

2007

Arq. Neuro-Psiquiatr.

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-Objective: To describe the clinical outcome and the complications of bacterial meningitis according to birth weight of out born neonates admitted in intensive care unit during an 11 year-period. Method: Eighty-seven newborns were studied. Thirty-four infants were low birth weight newborn and 53 presented birth weight ≥2500 g. The clinical data were obtained through the analysis of patients' files. Fisher's exact test, the χ 2 and the Mann-Whitney test were applied. Results: Neurological symptoms were more common in infants weighed ≥2500 g (p<0.05). Complications affected half of the cases in both groups. Complications affected half of the cases in both groups, with an overall mortality rate of 11.5%. Conclusion: The rate of complications was high in both groups, regardless of the birth weight. No association was observed between the occurrence of death and birth weight. Infants with positive CSF culture had a poorer prognosis.KEY WORDS: newborn, neonatal meningitis, central nervous system. Evolução clínica da meningite bacteriana neonatal de acordo com o peso de nascimento RESUMO -Objetivo: Descrever a evolução clínica e as complicações da meningite bacteriana de acordo com o peso de nascimento em recém-nascidos admitidos em unidade de terapia intensiva externa durante o período de 11 anos. Método: Foram estudados 87 neonatos, dos quais 34 foram recém-nascidos de baixo peso e 53 apresentaram peso ≥2500 g. Os dados clínicos foram obtidos por análise dos prontuários médicos. Foram realizados teste exato de Fisher, teste do χ 2 e teste de Mann-Whitney. Resultados: Os sintomas neurológi-cos foram mais comuns em neonatos com peso ≥2500 g (p<0,05 ). As complicações ocorreram na metade dos casos em ambos os grupos, com mortalidade global de 11.5%. Conclusão: A freqüência de complicações foi alta em ambos os grupos, independentemente do peso de nascimento. Não houve associação entre óbito e peso de nascimento. Os neonatos com cultura de líquor positiva apresentaram pior prognóstico.PALAVRAS-CHAVE: recém-nascido, meningite neonatal, sistema nervoso central. SP -Brasil. E-mail: verakrebs@uol.com.br Low birth weight newborns present a 3-fold increased risk of acquiring meningitis when compared to those whose birth weight is ≥2500 g 1 . Among very low birth weight neonates (<1500 g) the risk is a 10 to 17-fold higher [2][3][4] . In addition to the immaturity of the immunological system, these neonates frequently present risk factors for infection related to maternal diseases or neonatal conditions 1,3,5 . Dra. Vera Lúcia Jornada Krebs -Rua Iara 123 / 51 -04542-030 São PauloThe objective of this study was to describe the clinical outcome and the complications of bacterial meningitis according to birth weight of out born neonates admitted in intensive care unit during an 11 year-period. METHODEighty-seven newborns with bacterial meningitis who were admitted to the Neonatal Intensive Care Unit (NICU) of the Instituto da Criança, Hospital das Clínicas, University of São Paulo, from January 1 st , 1994 to December ...

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Section: Discussionmentioning

confidence: 46%

Clinical outcome of neonatal bacterial meningitis according to birth weight

Krebs¹,

Costa²

2007

Arq. Neuro-Psiquiatr.

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“…Ventriculitis may occur in 40 to 90% of the cases, particularly when bacteria persist in the CSF, while hydrocephaly is usually associated with ventriculitis and hemorrhage 24 . The frequency of abscesses was rather high (15%) in comparison with the rates of 1% to 3.4% reported in the literature 24,26 . Abscesses may develop slowly, and they are not always easily seen, which hinders diagnosis.…”

Section: Discussioncontrasting

confidence: 48%

Neonatal meningitis according to the microbiological diagnosis: a decade of experience in a tertiary center

Bentlin¹,

Ferreira²,

Rugolo³

et al. 2010

Arq. Neuro-Psiquiatr.

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The aim of this study was to evaluate the incidence of and mortality due to meningitis and compare data according to microbiological diagnosis. This was a ten-year retrospective study conducted at a neonatal intensive care unit (NICU). Newborns with meningitis confirmed by positive CSF culture were included; those with congenital infection or malformations that made lumbar puncture impossible were excluded. The variables investigated were birth weight, gestational and postnatal age, procedures, hematological and CSF parameters, and complications. Parametric and non-parametric tests were used (statistical value p<0.05). The incidence of meningitis was 0.6% and mortality was 27%. Of the 22 cases, 59% involved Gram-negative bacteria; 36% Gram-positive and 5% fungi. The groups did not differ in relation to birth weight, gestational and postnatal age, procedures or hematological and CSF parameters. Sepsis, convulsions and deaths were frequent in both groups, without statistical difference. Gram-negative cases showed abscesses and higher frequency of ventriculitis and hydrocephaly. Meningitis was infrequent, but presented high mortality and frequent complications. Key words: meningitis, newborn, central nervous system, sepsis.Meningite neonatal de acordo com diagnóstico microbiológico: uma década de experiência em centro terciário RESUMO O objetivo do estudo foi avaliar incidência e mortalidade da meningite e comparar dados de acordo com o diagnóstico microbiológico. Estudo retrospectivo, de 10 anos, em UTI Neonatal. Incluídos RNs com meningite confirmada por cultura de líquor positiva; RN com infecção congênita ou malformações que impedem punção lombar foram excluídos. Variáveis: peso ao nascimento, idades gestacional e pós natal, procedimentos, parâmetros hematológicos e liquóricos, complicações. Testes paramétricos e não paramétricos foram utilizados (valor estatístico p<0,05). A incidência de meningite foi de 0,6% e mortalidade de 27%. Dos 22 casos, 59% foram por bactérias Gram-negativas; 36% por bactérias Grampositivas e 5% por fungos. Grupos não diferiram quanto ao peso ao nascimento, idades gestacional e pós-natal, procedimentos e por parâmetros hematológicos e liquóricos. Sepse, convulsões e óbitos foram frequentes e não diferiram entre os grupos. Gramnegativos causaram abscessos e mais frequentemente ventriculite e hidrocefalia. Meningite não foi freqüente, mas apresentou alta mortalidade e complicações. Palavras-chave: meningite, recém-nascido, sistema nervoso central, sepse.

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“…Transmission to neonates occurs horizontally during nosocomial outbreaks in neonatal hospital wards (49). Also, colonized mothers may facilitate vertical transmission to their children (7,11,12). Immunocompromised individuals are also susceptible to Citrobacter infections (41).…”

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confidence: 99%

“…As a result, invasive surgical intervention or multiple aspirations of the abscessed tissue are often prescribed (11,33).…”

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confidence: 99%

“…More recent studies have determined that Citrobacter was able to invade and replicate within human brain microvascular endothelial cells (HBMEC), which constitute the blood-brain barrier (2). Clinical and experimental data suggest that the indolent nature of the infection and the resistance of the bacterium to phagocytic killing may play a role in abscess development (11,20).…”

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confidence: 99%

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Citrobacter koseriBrain Abscess in the Neonatal Rat: Survival and Replication within Human and Rat Macrophages

Townsend¹,

Pollack

González-Gómez

et al. 2003

Infect Immun

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A unique feature of Citrobacter koseri is the extremely high propensity to initiate brain abscesses during neonatal meningitis. Previous clinical reports and studies on infant rats have documented many Citrobacterfilled macrophages within the ventricles and brain abscesses. It has been hypothesized that intracellular survival and replication within macrophages may be a mechanism by which C. koseri subverts the host response and elicits chronic infection, resulting in brain abscess formation. In this study, we showed that C. koseri causes meningitis and brain abscesses in the neonatal rat model, and we utilized histology and magnetic resonance imaging technology to visualize brain abscess formation. Histology and electron microscopy (EM) revealed that macrophages (and not fibroblasts, astrocytes, oligodendrocytes, or neurons) were the primary target for long-term C. koseri infection. To better understand C. koseri pathogenesis, we have characterized the interactions of C. koseri with human macrophages. We found that C. koseri survives and replicates within macrophages in vitro and that uptake of C. koseri increases in the presence of human pooled serum in a dose-dependent manner. EM studies lend support to the hypothesis that C. koseri uses morphologically different methods of uptake to enter macrophages. Fc␥RI blocking experiments show that this receptor primarily facilitates the entry of opsonized C. koseri into macrophages. Further, confocal fluorescence microscopy demonstrates that C. koseri survives phagolysosomal fusion and that more than 90% of intracellular C. koseri organisms are colocalized within phagolysosomes. The ability of C. koseri to survive phagolysosome fusion and replicate within macrophages may contribute to the establishment of chronic central nervous system infection including brain abscesses.

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Brain abscess by citrobacter diversus in infancy: case report

Cited by 10 publications

References 8 publications

Clinical outcome of neonatal bacterial meningitis according to birth weight

Clinical outcome of neonatal bacterial meningitis according to birth weight

Neonatal meningitis according to the microbiological diagnosis: a decade of experience in a tertiary center

Citrobacter koseriBrain Abscess in the Neonatal Rat: Survival and Replication within Human and Rat Macrophages

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