Community-acquired adult Escherichia coli meningitis leading to diagnosis of unrecognized retropharyngeal abscess and cervical spondylodiscitis: a case report

Abstract

BackgroundEscherichia 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).Case presentationWe 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.ConclusionIn case of adult Escherichia coli meningitis, underlying diseases should always be carefully excluded, especially if predisposing factors are not apparent.

Community-acquired Escherichia coli meningitis and spondylodiscitis in an adult patient with discoid lupus erythematosus

“…We performed a more extensive diagnostic workup which included the search of endocarditis with a transoesophageal echocardiogram, PET-CT scan and MRI to find intra-abdominal or osteoarticular focus. We discovered a spondylodiscitis which was also described in a report of Kohlmann et al and Dobson et al [9,10].…”

Community-acquired Escherichia coli meningitis with ventriculitis in an adult—a rare case report

“…Among them, alcoholism with cirrhosis, uncontrolled diabetes, disseminated strongyloidiasis, HIV, and chronic organ dysfunction are the most common [ 1 ]. Previously reported cases identified the primary focus of E. coli from the urinary tract or GI tract, and a rare case report has identified the source as a retropharyngeal abscess [ 4 ]. In our case, the patient underwent a neurosurgical procedure for CSF leak two decades ago.…”

Septic shock due to Escherichia coli meningoencephalitis treated with immunoglobulin-M-enriched immunoglobulin preparation as adjuvant therapy: a case report

“…Escherichia coli strains are a relevant etiology of meningitis and meningoencephalitis in neonates and infants [13,14], being a relevant cause of both mortality and disability in this cohort of young patients [15,16]. In adults E. coli is, not unlike other Gramnegative bacteria, more often responsible for nosocomial meningitis/meningoencephalitis, in particular in posttraumatic and/or postneurosurgical patients [6][7][8][17][18][19]. On the other hand, as mentioned above, Escherichia coli accounts only for 1-3% of spontaneous community-acquired adult meningitis/meningoencephalitis [5][6][7][8].…”

“…In adults E. coli is, not unlike other Gramnegative bacteria, more often responsible for nosocomial meningitis/meningoencephalitis, in particular in posttraumatic and/or postneurosurgical patients [6][7][8][17][18][19]. On the other hand, as mentioned above, Escherichia coli accounts only for 1-3% of spontaneous community-acquired adult meningitis/meningoencephalitis [5][6][7][8]. Moreover, according to recent reviews of the few described cases of E. coli meningitis or meningoencephalitis [6,7], many of the patients had at least one relevant comorbidity or risk factor, such as cirrhosis or chronic alcoholism, diabetes mellitus, a history of chronic organ dysfunction, HIV infection, or another cause of immunodeficiency such as prolonged corticosteroid therapy or cancer.…”

“…Gram-negative bacteria are an uncommon etiology of spontaneous communityacquired meningitis in adults, representing only 0.7-8.7% of adult meningitis cases according to different authors [4,5]. Among Gram-negative bacteria, Escherichia coli (E. coli) represents 41.9% of all community-acquired Gram-negative cases in adults, accounting for an overall percentage of community-acquired meningitis in adult patients of about 1-3% [5][6][7][8].…”