Bacteroides fragilis concealed in an infant with Escherichia coli meningitis

Abstract

Anaerobic meningitis in infants is rare, therefore a high index of clinical suspicion is essential as routine methods for processing cerebrospinal fluid (CSF) do not detect anaerobes and specific antimicrobial therapy is required. We present an infant with Escherichia coli meningitis where treatment-resistance developed in association with culture negative purulent CSF. These features should have alerted us to the presence of anaerobes, prompting a search for the causes of polymicrobial meningitis in infants.

A chinese case of prevotella intermedia and streptococcus constellatus intracranial mixed infection

“…It might be a feasible way to combine gram staining with the characteristics and odor of CSF so as to identify meningitis with mixed infection of anaerobic bacteria preliminarily. Bacteroides fragilis concealed in an infant with Escherichia coli meningitis, and the apparent concealment of B. fragilis among E. coli in the CSF was possible because of their morphologic similarity; both organisms appeared as gram-negative, rod-shaped bacteria(Ganeshalingham et al 2014 ). Frank pus was obtained from the E. coli and B. fragilis mixed infectious meningitis (Ganeshalingham et al 2014 ).…”

“…Bacteroides fragilis concealed in an infant with Escherichia coli meningitis, and the apparent concealment of B. fragilis among E. coli in the CSF was possible because of their morphologic similarity; both organisms appeared as gram-negative, rod-shaped bacteria(Ganeshalingham et al 2014 ). Frank pus was obtained from the E. coli and B. fragilis mixed infectious meningitis (Ganeshalingham et al 2014 ). Foul smelling pus also appeared in the brain abscess due to Streptococcus spp.…”

“…In anaerobes, production of β-lactamases is the most common mechanism of β-lactam resistance and is most frequently encountered in the B. fragilis group and the genus Prevotella with significant interspecies differences (Dubreuil et al 2003 ). In an infant with E. coli and B. fragilis mixed infectious meningitis (Ganeshalingham et al 2014 ), B. fragilis was confirmed resistant to ceftriaxone. In an in-vitro susceptibility test (Weintraub et al 2016 ), Prevotella isolates were susceptible to metronidazole but resistant to ceftriaxone.…”

“…In diagnosis of cerebral infarction accompanied by meningitis with mixed infection, it is important for patients to receive imaging examination. Imaging of the brain and spine should be performed in a timely manner and reviewed specifically(Ganeshalingham et al 2014 ). Brain CT scan and contrast-enhanced magnetic resonance images contributed to discovering cervical spinal epidural abscess and meningitis (Frat et al 2004 ).…”

Severe bacterial meningitis due to an enterothecal fistula in a 6-year-old child with Currarino syndrome: evaluation of surgical strategy with review of the literature

“…The known female predominance of Currarino syndrome was confirmed with a F:M ratio of 24:13 (information on the gender of one patient missing). These case reports show that meningitis due to formation of an enterothecal fistula can be fatal [1,16,17]. In the series here described, a posterior surgical approach was chosen in 16 patients and an anterior surgical approach was chosen in 3 patients.…”