Neisseria cinerea in a Post-splenectomy Patient: A Rare Potentially Fatal Bacteremia

Abstract

Neisseria cinerea is a commensal which usually resides in the human respiratory tract. Very rarely, the organism finds its way into the bloodstream causing severe bacteremia. So far, very few cases of Neisseria bacteremia have been reported. We report a case of a 78-year-old male, post-splenectomy, who presented with high fever, cough and shortness of breath. The patient was initially managed for septic shock with fluid resuscitations, vasopressors and broad-spectrum antibiotics. Later, the blood cultures grew gram-negative coccobacilli, Neisseria cinerea. The patient was successfully treated with intravenous ceftriaxone. This is the first case ever of Neisseria cinerea bacteremia in a post-splenectomy patient and ninth case overall. This case illustrates that the physicians should maintain heightened awareness for Neisseria cinerea bacteremia in post-splenectomy patients.

Recurrent Neisseria cinerea bacteremia secondary to cardiovascular implantable electronic device infection

“…While N. cinerea is generally considered a commensal organism, cases of invasive infection have been reported, primarily occurring in immunocompromised hosts. The spectrum of disease is broad and includes ocular infections in pediatric patients, particularly neonates [11] , [12] , [13] , pulmonary infection [14] , [15] , peritonitis in patients receiving peritoneal dialysis [16] , [17] , [18] , and bacteremia [4] , [6] , [10] , [15] , [19] , [20] , [21] , [22] . Infection of the central nervous system has been reported, although was probably due to direct inoculation in both cases [10] , [20] .…”

“…Infection with N. cinerea is often seen in immunocompromised conditions. In cases of bacteremia, reported risk factors include myelodysplastic syndrome, intravenous drug use, alcohol abuse, and asplenia [6] , [15] , [21] , [22] . Another report risk factor appears to be the complement inhibitor eculizumab.…”

“…However, unlike N. meningitidis and N. gonorrhoeae , N. cinerea has a low potential for pathogenicity and infection is rare [4] . There have been very few reported cases of N. cinerea infection and only one causing tricuspid valve infective endocarditis [5] , [6] . Here we present the first case of N. cinerea bacteremia with probable cardiovascular implantable electronic device (CIED) infection.…”

Neisseria Cinerea Bacteremia Secondary to a Retropharyngeal Abscess

“…The cases of Neisseria cinerea bacteremia include one case of posttraumatic meningitis with bacteremia, bacteremia in one post-splenectomy patient, one patient with AIDS, and one case of endocarditis in an intravenous drug user. Other cases of infections involving Neisseria cinerea include two patients with continuous ambulatory peritoneal dialysis (CAPD)associated peritonitis, two cases of pulmonary infections in immunosuppressed patients, one case of proctitis in a child, and several cases of purulent conjunctivitis in neonates [1][2][3][4][5].…”

“…Neisseria cinerea is a commensal bacteria of the human oropharynx, with low pathogenic potential, and very few reported cases of bacteremia [1]. Only a handful of case reports involving invasive N. cinerea infections are documented; and the affected patients had underlying comorbidities and immunosuppression [1][2][3][4]. Furthermore, retropharyngeal abscesses are rare in adults, and are usually attributable to local trauma, such as fishbone ingestion or instrumentation [5,6].…”