Community-Acquired Meningitis and Sepsis Caused by Chryseobacterium meningosepticum in a Patient Diagnosed with Thalassemia Major

Abstract

Chryseobacterium meningosepticum is a rare pathogen in cases of bacterial meningitis in adults and adolescents. We report on the case history of a 17-year-old boy with thalassemia major and meningitis and sepsis caused by C. meningosepticum in splenectomized. The patient received vancomycin therapy for 21 days and was discharged in a state of complete recovery. CASE REPORTA 17-year-old boy was diagnosed with thalassemia major (TM) at the age of 12 months. His ␤-thalassemia mutation was IVS-I-110 (G3A), homozygous state. He was treated with regular blood transfusions at 3-to 4-week intervals to maintain pretransfusion hemoglobin levels above 9.5 g/dl. Desferrioxamine treatment was started when the boy was 3 years of age. Because of an increasing requirement for packed red cells, he was splenectomized in 2000. Despite receiving desferrioxamine therapy, he was heavily iron loaded, so an orally active chelator, deferiprone (L 1 ,1,2-dimethyl-3-hydroxypiridin-4-one), was added 6 months before the condition described here occurred. The latest serum ferritin level was 2,750 ng/dl. The patient did not have heart failure, diabetes mellitus, or cirrhosis of liver. There was no previous history of significant infection.On 20 September 2005, the patient was admitted with fever, headache, and progressive disturbances of consciousness that had lasted for 2 days. On admission, physical examination revealed a pale and toxic appearance. He had positive signs of meningeal irritation. His body temperature was 39.2°C, his heart rate was 124 beats/min, his respiratory rate was 20/min, his blood pressure was 105/50 mm Hg, his body weight was 41 kg, and his body height was 155 cm. Hepatomegaly and a scar from the splenectomy were noted. Blood and cerebrospinal fluid (CSF) samples were taken and sent to the laboratory for culture and biochemical analyses. Results of the laboratory testing showed a white blood cell (WBC) count of 9 ϫ 10 3 /l (90% neutrophils), a hemoglobin concentration of 6.1 g/dl, a hematocrit of 18.2%, a platelet count of 258 ϫ 10 3 /l, an urea concentration of 30 mg/dl, a creatinine concentration of 1.2 mg/dl, a glucose concentration of 108 mg/dl, an aspartate aminotransferase concentration of 100 U/liter, an alanine aminotransferase concentration of 102 U/liter, a sodium level of 38 meq/liter, a potassium level of 4.0 meq/liter, an erythrocyte sedimentation rate of 150 mm/h, and a C-reactive protein concentration of 4.0 mg/dl. Study of the CSF revealed the following results: a WBC count of 5,200/mm 3 , a glucose concentration of 20 mg/dl, a protein concentration of 92 mg/dl, and a chloride level of 124 meq/liter; the CSF was negative by Gram staining. All of the remaining biochemical laboratory tests were unremarkable. A chest radiograph and computed tomography of the brain were normal. Empirical therapy with intravenous vancomycin at 60 mg/kg of body weight/day (maximum dose, 2 g/day) was initiated. The CSF specimen was cultured on 5% sheep blood, eosin-methylene blue, and chocolate agars at 35°C in 5 to 10% CO 2 ...

Iron Homeostasis and the Inflammatory Response

“…Iron overload associated with hereditary hemochromatosis has been reported to confer susceptibility to other infectious pathogens, such as Yersinia enterocolitica and Vibrio vulnificus (10, 28, 50). Infections are more frequent in thalassemic patients with iron overload induced by frequent blood transfusions (49, 105). Iron status also appears to strongly influence the course of viral infections (30).…”

Antimicrobial activities of blinding tree, Excoecaria agallocha against selected bacterial pathogens

“…meningosepticum was usually resistant to multiple antibiotics. Otherwise, it was susceptible to fluoroquinolones and trimethoprim-sulfamethoxazole, andvancomycin (Ozkalay et al, 2006). These resistance phenoltypes could be explained by the presence of betalactamases, including extended-spectrum beta-lactamases and metallo-beta-lactamases (Vessillier et al, 2002).…”

Elizabethkingia species sepsis after lung transplantation: case report and literature review

“…E. meningoseptica has been historically associated with neonatal meningitis and sepsis with a high case‐fatality rate . In adults, Elizabethkingia has been implicated in a variety of infectious syndromes including bloodstream infections , pneumonia , meningitis , skin and soft tissue infections , intra‐abdominal sepsis , and orthopedic infections , among others. Hence, the clinical presentation in our patient is typical of the bloodstream infection and sepsis that have been previously described.…”