Elizabethkingia miricola Causes Intracranial Infection: A Case Study

Abstract

Background:Elizabethkingia miricola is a rarely encountered bacterium in clinical practice. It is a rare gram-negative rod-shaped bacterium associated with lung and urinary tract infections, but never found in cerebrospinal fluid. This paper reports a case of an adult patient infected by E. miricola via an unknown route of infection causing a severe intracranial infection. Elizabethkingia miricola was detected by culture and Metagenomic next generation sequencing in CSF. Early identification of this strain and treatment with sensitive antibiotics is necessary to reduce morbidity and mortality.Case Report: A 24-year-old male was admitted to a West China Hospital because of headache and vomiting for 2 months. Symptom features included acute onset and long duration of illness. Notably, headache and vomiting were the primary neurological symptoms. Routine cerebrospinal fluid culture failed to identify the bacterium; however, Elizabethkingia miricola bacterium was detected via second-generation sequencing techniques. Elizabethkingia miricola was found to be a multi-drug resistant organism, hence, treatment with ceftriaxone, a commonly used drug for intracranial infections was ineffective. This strain eventually caused severe intracranial infection resulting in the death of the patient.Conclusion: In summary, this study comprehensively describes a case of an adult patient infected by E. miricola and discusses its early identification as well as application of sensitive antibiotics in the emergency setting.

Acute bacterial encephalitis complicated with recurrent nasopharyngeal carcinoma associated with Elizabethkingia miricola infection: A case report

“…Globally, only one case of meningoencephalitis caused by E. miricola has been reported, and the patient did not receive a timely diagnosis and treatment. Consequently, the patient died a few days after being discharged from the hospital (6). Due to the rarity and unknown etiology of the disease in the central nervous system, its diagnosis and treatment remain poorly understood.…”

“…This potentially masks the exact clinical significance of the bacterium. The first case of intracranial E. miricola infection was initially misdiagnosed as E. meningosepticum, which led to a delay in diagnosis and treatment (6). Therefore, it is challenging to determine the pathogenic role of infrequent isolates in patients with low immunity.…”

“…In addition, E. miricola is known to be multidrug-resistant, and there is no best-known therapy for neurologic E. miricola infection (6,11). A previous study has revealed that E. miricola in neurologic infection was resistant to ceftriaxone and imipenem but susceptible to tigecycline, cefoperazone/sulbactam, levofloxacin, among other drugs (6).…”

“…In addition, E. miricola is known to be multidrug-resistant, and there is no best-known therapy for neurologic E. miricola infection (6,11). A previous study has revealed that E. miricola in neurologic infection was resistant to ceftriaxone and imipenem but susceptible to tigecycline, cefoperazone/sulbactam, levofloxacin, among other drugs (6). Similar to the previously reported case of E. miricola infection, our patient received cefoperazone/sulbactam therapy for 2 weeks during hospitalization, and his symptoms were significantly relieved.…”

“…However, E. miricola is rarely known to cause a neurologic infection. To date, only one case of meningoencephalitis caused by E. miricola has been reported, and the patient eventually died due to symptoms of aggravation (6). In addition, medically important species of Elizabethkingia include Elizabethkingia meningosepticum, Elizabethkingia anophelis, and E. miricola.…”