Proteus Mirabilis Septicemia and Meningitis in a Neonate

Abstract

A 6-day-old premature baby boy presented in a pediatric clinic for severe jaundice, poor feeding and lethargy. He was born to a 24-year-old mother who was primigravida. Pregnancy was complicated by gestational diabetes, appropriately treated chlamydial infection, oligohydramnios and inadequate prenatal care. On physical examination, he was hypotonic and irritable with significant jaundice seen from his head to his lower extremities. Transcutaneous bilirubin obtained in clinic showed a level of 14 mg/dL. A serum bilirubin level was immediately ordered and it confirmed an elevated unconjugated bilirubin level of 18.9 mg/dL. He was admitted to the inpatient unit and a full septic work-up was initiated. Appropriate antibiotics were administered to cover for the most common pathogen involved in neonatal sepsis. A few hours into the admission, his condition deteriorated requiring intubation for multiple consecutive apneic episodes and seizure-like activity. Initial laboratory evaluation included an abnormal white blood cell count of 2,600/µL with left shift, elevated lactic acid of 9 mmol/L and a low bicarbonate level of 16 mmol/L further confirming acidosis. Analysis of cerebrospinal fluid revealed a white blood cell count of > 300/µL, low glucose with a level of 7 mg/dL and elevated protein level of 645 mg/dL. Due to his rapid clinical deterioration a few hours into the admission, a computed tomography scan of the brain was obtained. Computed tomography scan of brain showed significant damage to brain parenchyma consistent with anoxic brain injury. He expired on his second day of admission. Proteus mirabilis was the causative agent.

Incidence of antibiogram, antibiotic resistance genes and class 1 and 2 integrons in tribeProteeaewith IMP27 gene for the first time inProvidenciasp. isolated from pet turtles

“…As an opportunistic pathogen, they have been reported to cause wound infections, respiratory tract infections, diabetic foot ulcers and meningitis bloodstream infections as septicemia (Manos and Belas ; Albornoz et al . ; Omoruyia and Evangelista ). Proteus mirabilis is a recurrent cause of urinary tract infections that are difficult to treat (Manos and Belas ).…”

“…Proteeae is a tribe, whose organisms are opportunistic pathogens, found in the environment and in the intestinal tracts of humans and animals as a part of their normal microflora and consists of three genera: Proteus , Providencia and Morganella (Hegazy ). Proteeae are known as a nosocomial, opportunistic pathogen and more common in community‐acquired infections (Omoruyia and Evangelista ). Virulence of the Proteus sp.…”

Uncommon Pathogens Causing Hospital-Acquired Infections in Postoperative Cardiac Surgical Patients

“…Proteus is commonly implicated in infections of urinary tract (1-10% of all infections). 69 In addition to UTIs, Proteus can also cause infections in the respiratory tract, eye, ear, nose, skin, throat, burns, aortic aneurysm, 70 and wounds, 71 and has been implicated in neonatal meningoencephalitis, 72 empyema, and osteomyelitis. Many of the infections occur by means of ascension of the organism from gastrointestinal tract, as has been proven by the isolation of same organism from stool specimens in many cases.…”

Case Report of Neonatal Proteus mirabilis Meningitis and Brain Abscess with Negative Initial Image Finding: Consideration of Serial Imaging Studies

“…The patient showed slight tonic movements suggestive of seizure activity and phenobarbital loading was started. A second CSF analysis showed a markedly decreased , hydrocephalus 2) , extensive pneumocephalus 5) , global anoxic injury 6) , or hemorrhagic meningoencephalitis 7) . In our patient, brain CT was performed on day 3 of admission, which was 2 days after symptom onset, and showed normal findings.…”

“…The initial choices of antibiotics are mainly ampicillin or penicillin with a combination of aminoglycosides [2][3][4][5][6][7] . Antibiotics can be changed to chloramphenicol, cefotaxime, and meropenem if the patient's condition deteriorates 5) , fever persists despite…”