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Hasegawa S, Matsumoto E, Carlson JR, Suzuki H. Clinical Characteristics, Treatment, and Outcomes of Veterans with Cerebrospinal Fluid Culture Positive for Gram-Negative Rod Bacteria: A Retrospective Analysis over 18 Years in 125 Veterans Health Administration Hospitals. Curr Microbiol 2024; 81:70. [PMID: 38240847 DOI: 10.1007/s00284-023-03593-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/15/2023] [Indexed: 01/23/2024]
Abstract
Optimal management for patients with bacterial ventriculitis/meningitis due to Gram-negative rods (GNRs) has yet to be well investigated. We assessed the clinical characteristics, treatment, and outcomes of patients with a positive cerebrospinal fluid (CSF) culture for GNRs. We conducted a retrospective cohort study of all patients with a positive CSF culture within the Veterans Health Administration (VHA) system during 2003-2020. Clinical and microbiological characteristics between the true meningitis and contamination groups were compared. Of the 5919 patients with positive CSF cultures among 125 nationwide VHA acute-care hospitals, 297 (5.0%) were positive for GNRs. Among 262 patients analyzed, 156 (59.5%) were assessed as patients with true meningitis, and 106 (40.5%) were assessed as patients with contaminated CSF cultures. Patients with true meningitis had a significantly higher CSF protein (median 168 vs 57 mg/dL, p < 0.001), CSF white blood cell count (median 525 vs 3/µL, p = 0.008) and percentage of neutrophils in CSF (median 88 vs 4%, p < 0.001). Enterobacterales were more common in the true meningitis group, while unidentified GNR or polymicrobial CSF cultures were more common in the contamination group. The all-cause 90-day mortality was 25.0% (39/156) in patients with true meningitis and 10.4% (11/106) in those with contaminated CSF cultures. None of the 11 patients with contaminated CSF cultures who died were considered due to missed meningitis. More than 40% of patients with a positive CSF culture with GNR did not receive treatment without negative consequences. Careful clinical judgment is required to decide whether to treat such patients.
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Affiliation(s)
- Shinya Hasegawa
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, 601 Highway 6 West, Iowa City, IA, 52246, USA
- Iowa City Veterans Affairs Health Care System, 601 Highway 6 West, Iowa City, IA, 52246, USA
| | - Eiyu Matsumoto
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, 601 Highway 6 West, Iowa City, IA, 52246, USA
- Iowa City Veterans Affairs Health Care System, 601 Highway 6 West, Iowa City, IA, 52246, USA
| | - Jennifer R Carlson
- Iowa City Veterans Affairs Health Care System, 601 Highway 6 West, Iowa City, IA, 52246, USA
| | - Hiroyuki Suzuki
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, 601 Highway 6 West, Iowa City, IA, 52246, USA.
- Iowa City Veterans Affairs Health Care System, 601 Highway 6 West, Iowa City, IA, 52246, USA.
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Sood R, Walo C, Burton R, Khalife M, Dicko A, Mangana F. Spontaneous nosocomial Proteus mirabilis meningitis in a Human Immunodeficiency Virus (HIV)-infected adult patient: a case report. J Med Case Rep 2023; 17:52. [PMID: 36755276 PMCID: PMC9909980 DOI: 10.1186/s13256-022-03704-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 12/01/2022] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Gram-negative bacillary meningitis remains a rare occurrence, even in patients with human immunodeficiency virus. Current literature only describes anecdotal cases of spontaneous nosocomial Proteus mirabilis meningitis. This report describes the clinical manifestations and management of a patient with healthcare-associated spontaneous Gram-negative bacillary meningitis in a patient with advanced human immunodeficiency virus disease. CASE PRESENTATION A 23-year-old Congolese female was hospitalized in a human immunodeficiency virus specialized center for ongoing weight loss, chronic abdominal pain, and vomiting 9 months after initiation of treatment for tuberculosis meningitis. Hospitalization was complicated by healthcare-associated Gram-negative bacillary meningitis on day 18. Blood and cerebrospinal fluid cultures confirmed Proteus mirabilis. Antibiotic susceptibility testing showed extended spectrum beta-lactamase resistant to common antibiotics, and sensitive to meropenem. Despite initiation of high-dose meropenem by intravenous infusion (2 g every 8 hours), the patient did not improve, and died after 4 days of meropenem treatment. Gram-negative bacillary meningitis remains rare and is associated with an unfavorable prognosis. CONCLUSIONS This case report highlights the importance of microbiological identification of pathogens in resource-limited settings. As Gram-negative bacillary meningitis does not present with pleocytosis in patients with advanced human immunodeficiency virus, a negative lumbar puncture cannot exclude this diagnosis. Access to clinical bacteriology in resource-limited settings is essential to enable correct antibiotic treatment and avoid overuse of antibiotics to which there is already resistance. It further plays an essential role in public health by identifying antibiotic susceptibilities. Infection prevention and control measures must be reinforced in order to protect patients from such avoidable healthcare-associated infections.
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Affiliation(s)
- Radhika Sood
- grid.150338.c0000 0001 0721 9812Internal Medicine Department, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Chadrack Walo
- Centre Hospitalier Kabinda, Médecins Sans Frontieres, Commune de Lingwala, Kinshasa, Democratic Republic of Congo
| | - Rosie Burton
- SAMU, Médecins Sans Frontieres, Kinshasa, Democratic Republic of Congo
| | - Mohamad Khalife
- Médecins Sans Frontieres, Kinshasa, Democratic Republic of Congo
| | - Astan Dicko
- Laboratory of Centre Hospitalier Kabinda, Médecins Sans Frontieres, Kinshasa, Democratic Republic of Congo
| | - Freddy Mangana
- Centre Hospitalier Kabinda, Médecins Sans Frontieres, Commune de Lingwala, Kinshasa, Democratic Republic of Congo.
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Ray A, Basu S, Das S, Chandra A. Gram-negative bacillary meningitis in an immunocompetent adult. BMJ Case Rep 2023; 16:e251850. [PMID: 36627135 PMCID: PMC9835857 DOI: 10.1136/bcr-2022-251850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Escherichia coli is a rare cause of community-acquired meningitis comprising about 1% of adult cases. However, it is a common pathogen in neonatal meningitis and in nosocomial setting (especially after penetrating craniocerebral injury or subsequent to neurosurgical procedures). We report a middle-aged woman, who was admitted with features of acute meningitis and subsequent investigations revealed E. coli growth in cerebrospinal fluid culture. The case is distinctive as no additional predisposing risk factors associated with gram-negative bacillary meningitis (traumatic brain injury, neurosurgical procedures, malignancy, immunosuppressive therapy, HIV infection, chronic alcoholism and diabetes) were present. She was treated with intravenous antibiotics as per sensitivity reports and discharged in clinically stable condition, without any residual neurological deficit.
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Affiliation(s)
- Aniruddha Ray
- Internal Medicine, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Satyaki Basu
- Internal Medicine, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Souradeep Das
- Internal Medicine, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Atanu Chandra
- Internal Medicine, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
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Klebsiella pneumoniae-related invasive liver abscess syndrome complicated by purulent meningitis: a review of the literature and description of three cases. BMC Infect Dis 2021; 21:15. [PMID: 33407192 PMCID: PMC7788956 DOI: 10.1186/s12879-020-05702-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 12/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background Klebsiella pneumoniae (K. pneumoniae) invasive liver abscess syndrome (ILAS) with purulent meningitis was rarely identified the mainland of China. Last winter, we received 3 cases of K. pneumoniae meningitis and all of them died in a short time. We report these cases in order to find the reason of high mortality and discuss effective effort to improve these patients’ prognosis. Case presentation Three patients with uncontrolled diabetes developed live abscess and purulent meningitis. Upon admission, the clinical manifestations, laboratory result of blood and cerebrospinal fluid (CSF) and imaging examinations were compatible with K. pneumoniae ILAS which had metastasis infection of meningitis. Even with timely adequate antibiotic therapy and strict glycemic control, all of the patients’ condition deteriorated rapidly and died in a short time. Conclusion The reason of patients’ poor prognosis might be the absence of liver abscess drainage, high level of CSF protein which indicates severe inflammation and unknown special but stronger virulence factors of K. pneumoniae the patients’ living place Zhangjiakou. Strict glycemic control, early drainage of liver abscess and appropriate antibiotic application are recommended for treating this condition, further progress on the pathogenesis and treatment of K. pneumoniae meningitis may help patients gain a better prognosis.
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Meyfroidt G, Kurtz P, Sonneville R. Critical care management of infectious meningitis and encephalitis. Intensive Care Med 2020; 46:192-201. [PMID: 31938828 DOI: 10.1007/s00134-019-05901-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 12/14/2019] [Indexed: 01/14/2023]
Affiliation(s)
- Geert Meyfroidt
- Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Leuven, Belgium. .,Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium.
| | - Pedro Kurtz
- Neuro-Critical Care Unit, Instituto Estadual Do Cérebro Paulo Niemeyer and Hospital Copa Star, Rio de Janeiro, Brasil
| | - Romain Sonneville
- Université de Paris, INSERM UMR1148, team 6, 75018, Paris, France.,APHP, Intensive Care Medicine, Hôpital Bichat-Claude Bernard, 75018, Paris, France
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6
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Lien CY, Lee JJ, Tsai WC, Chen SY, Huang CR, Chien CC, Lu CH, Chang WN. The clinical characteristics of spontaneous Gram-negative bacterial meningitis in adults: A hospital-based study. J Clin Neurosci 2019; 64:101-105. [PMID: 31005474 DOI: 10.1016/j.jocn.2019.03.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 03/25/2019] [Indexed: 11/28/2022]
Abstract
The epidemiologic trend of acute bacterial meningitis can change more dramatically than any other bacterial disease, and a decrease in spontaneous adult bacterial meningitis (ABM) has been noted in serial studies of the epidemiologic trend of ABM in Taiwan. The purpose of this study was to analyze the clinical characteristics, laboratory data and therapeutic outcomes of 149 patients with spontaneous Gram-negative (G(-)) ABM collected during a study period of 31 years (1986-2016). The 149 patients included 107 men and 42 women, aged 18-86 years. The common underlying conditions were diabetes mellitus, liver cirrhosis and alcoholism, and the leading clinical presentations were fever, altered consciousness and septic shock. Compared the clinical characteristics of the patients identified in the study period of 2001-2106 to the patients identified in the study period of 1986-2000, the former group of patients had a significantly higher incidence of systemic malignance. In the recent 16 years (2001-2016), Klebsiella pneumoniae, Pseudomonas spp. and Escherichia coli were the leading three implicated bacterial pathogens of spontaneous G(-) ABM, accounting for 61.3% (38/62), 11.3% (7/62) and 11.3% (7/62%) of all cases, respectively. The overall mortality rate from spontaneous G(-) ABM was high (47.0%, 70/149) and the presence of septic shock and lower cerebrospinal fluid glucose level were significant prognostic factors. Because of the decreasing incidence of spontaneous ABM in Taiwan, close examination of this specific infectious syndrome is important in order to monitor the epidemiologic trend and improve the therapeutic strategy.
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Affiliation(s)
- Chia-Yi Lien
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jun-Jun Lee
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Information Management, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Wan-Chen Tsai
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shih-Ying Chen
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chi-Ren Huang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chun-Chih Chien
- Department of Laboratory Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Cheng-Hsien Lu
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Wen-Neng Chang
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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7
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Bodilsen J, Brouwer MC, Kjærgaard N, Sirks MJ, van der Ende A, Nielsen H, van de Beek D. Community-acquired meningitis in adults caused by Escherichia coli in Denmark and The Netherlands. J Infect 2018; 77:25-29. [PMID: 29859862 DOI: 10.1016/j.jinf.2018.05.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We aimed to examine risk factors, presenting characteristics and complications of Escherichia coli community-acquired bacterial meningitis in adults. METHODS Observational cohort study of adults > 16 years of age with cerebrospinal fluid culture-positive E. coli meningitis in Denmark and the Netherlands. Exclusion criteria were primary brain abscess, previous neurosurgery and nosocomial infections. We analysed baseline characteristics, concomitant infections and neurological complications. Outcome was assessed using the Glasgow Outcome Scale score (GOS) at discharge with GOS 1-4 categorised as unfavourable outcome. RESULTS We identified 36 patients with a median age of 69 years (interquartile range 61-83) of whom 15 (42%) were females. Immuno-compromise was present in 11 (31%) patients. Nineteen (53%) patients had concomitant infections consisting of urinary tract infections in 13 (36%), pneumonia in three (9%) and septic arthritis in two (6%). Bacteraemia with E. coli was found in 26 of 34 (76%) patients. Thirteen patients died (36%) and unfavourable outcome at discharge occurred in 23 (64%). Deaths were attributed to systemic complications in 12 (92%) patients. CONCLUSION Community-acquired E. coli meningitis in adults is a severe disease that primarily occurs in elderly patients with concomitant infections and an immunocompromised state. Outcome is often poor and mainly caused by systemic complications.
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Affiliation(s)
- Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.
| | - Matthijs C Brouwer
- Department of Neurology, Amsterdam Neuroscience, Academic Medical Centre, Amsterdam, The Netherlands
| | - Nicolai Kjærgaard
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Marc J Sirks
- Department of Neurology, Amsterdam Neuroscience, Academic Medical Centre, Amsterdam, The Netherlands
| | - Arie van der Ende
- Department of Medical Microbiology, Academic Medical Center, Amsterdam Infection & Immunity Institute, Amsterdam, The Netherlands; Netherlands Reference Laboratory for Bacterial Meningitis, Academic Medical Center, Amsterdam, The Netherlands
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Diederik van de Beek
- Department of Neurology, Amsterdam Neuroscience, Academic Medical Centre, Amsterdam, The Netherlands
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8
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Bichon A, Aubry C, Dubourg G, Drouet H, Lagier JC, Raoult D, Parola P. Escherichia coli spontaneous community-acquired meningitis in adults: A case report and literature review. Int J Infect Dis 2017; 67:70-74. [PMID: 29225070 DOI: 10.1016/j.ijid.2017.12.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 11/28/2017] [Accepted: 12/01/2017] [Indexed: 11/25/2022] Open
Abstract
Gram-negative bacillary meningitis occurring post-trauma and following neurosurgical procedures has been described widely. However, reports of spontaneous cases are sparse, particularly community-acquired cases. Spontaneous community-acquired Escherichia coli meningitis is a rare (although increasingly seen) and specific entity that is poorly reported in the literature. A review of the literature identified only 43 cases of community-acquired E. coli meningitis reported between 1946 and 2016. This article describes two new cases of spontaneous community-acquired E. coli meningitis encountered in Marseille, France, and presents the results of a literature review on spontaneous community-acquired E. coli meningitis.
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Affiliation(s)
- A Bichon
- Aix Marseille Université, CNRS 7278, IRD 198, INSERM 1095, AP-HM, URMITE, IHU Méditerranée-Infection, 19-21 Boulevard Jean Moulin, 13385 Marseille, Cedex 5, France
| | - C Aubry
- Aix Marseille Université, CNRS 7278, IRD 198, INSERM 1095, AP-HM, URMITE, IHU Méditerranée-Infection, 19-21 Boulevard Jean Moulin, 13385 Marseille, Cedex 5, France
| | - G Dubourg
- Aix Marseille Université, CNRS 7278, IRD 198, INSERM 1095, AP-HM, URMITE, IHU Méditerranée-Infection, 19-21 Boulevard Jean Moulin, 13385 Marseille, Cedex 5, France
| | - H Drouet
- Aix Marseille Université, CNRS 7278, IRD 198, INSERM 1095, AP-HM, URMITE, IHU Méditerranée-Infection, 19-21 Boulevard Jean Moulin, 13385 Marseille, Cedex 5, France
| | - J-C Lagier
- Aix Marseille Université, CNRS 7278, IRD 198, INSERM 1095, AP-HM, URMITE, IHU Méditerranée-Infection, 19-21 Boulevard Jean Moulin, 13385 Marseille, Cedex 5, France
| | - D Raoult
- Aix Marseille Université, CNRS 7278, IRD 198, INSERM 1095, AP-HM, URMITE, IHU Méditerranée-Infection, 19-21 Boulevard Jean Moulin, 13385 Marseille, Cedex 5, France
| | - P Parola
- Aix Marseille Université, CNRS 7278, IRD 198, INSERM 1095, AP-HM, URMITE, IHU Méditerranée-Infection, 19-21 Boulevard Jean Moulin, 13385 Marseille, Cedex 5, France.
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9
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Keddy KH, Sooka A, Musekiwa A, Smith AM, Ismail H, Tau NP, Crowther-Gibson P, Angulo FJ, Klugman KP. Clinical and Microbiological Features of Salmonella Meningitis in a South African Population, 2003-2013. Clin Infect Dis 2016; 61 Suppl 4:S272-82. [PMID: 26449942 DOI: 10.1093/cid/civ685] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The clinical and microbiological characteristics of nontyphoidal Salmonella (NTS) meningitis in South Africa, where human immunodeficiency virus (HIV) prevalence is high (approximately 15% in persons ≥15 years of age), were reviewed. METHODS From 2003 through 2013, 278 cases were identified through national laboratory-based surveillance. Clinical information (age, sex, outcome, Glasgow Coma Scale [GCS], and HIV status) was ascertained at selected sites. Isolates were serotyped; susceptibility testing and multilocus sequence typing on Salmonella enterica serovar Typhimurium isolates was performed. Multivariable logistic regression was used to determine factors associated with mortality outcome, using Stata software, version 13. RESULTS Where age was ascertained, 139 of 256 (54.3%) patients were <15 years. Males represented 151 of 267 (56.6%). Mortality outcome was recorded for 112 of 146 (76.7%) enhanced surveillance patients; 53 of 112 (47.3%) died. Death was associated with GCS ≤13 (adjusted odds ratio [OR], 18.7; 95% confidence interval [CI], 3.0-118.5; P = .002) on multivariable analysis. Where data were available, all 45 patients aged >15 years were HIV infected, compared with 24 of 46 (52.2%) patients aged <5 years. Neonates were less likely to be HIV infected than infants aged 2-12 months (OR, 4.8; 95% CI, 1.1-21.1; P = .039).Salmonella Typhimurium represented 106 of 238 (44.5%) serotyped isolates: 65 of 95 (68.4%) were ST313 vs ST19, respectively, and significantly associated with HIV-infected patients (P = .03) and multidrug resistance (OR, 6.6; 95% CI, 2.5-17.2; P < .001). CONCLUSIONS NTS meningitis in South Africa is highly associated with HIV in adults, with neonates (irrespective of HIV status), and with Salmonella Typhimurium ST313. GCS is the best predictor of mortality: early diagnosis and treatment are critical. Focused prevention requires further studies to understand the sources and transmission routes.
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Affiliation(s)
- Karen H Keddy
- Centre for Enteric Diseases, National Institute for Communicable Diseases Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
| | - Arvinda Sooka
- Centre for Enteric Diseases, National Institute for Communicable Diseases
| | - Alfred Musekiwa
- International Emerging Infections Programme, South Africa Global Disease Detection Centre, Centers for Disease Control and Prevention, Pretoria
| | - Anthony M Smith
- Centre for Enteric Diseases, National Institute for Communicable Diseases Faculty of Health Sciences, University of the Witwatersrand, Johannesburg
| | - Husna Ismail
- Centre for Enteric Diseases, National Institute for Communicable Diseases
| | - Nomsa P Tau
- Centre for Enteric Diseases, National Institute for Communicable Diseases
| | - Penny Crowther-Gibson
- Division of Public Health Surveillance and Response, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Frederick J Angulo
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention
| | - Keith P Klugman
- Faculty of Health Sciences, University of the Witwatersrand, Johannesburg Hubert Department of Global Health, Rollins School of Public Health, and Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia
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Kwambana-Adams B, Darboe S, Nabwera H, Foster-Nyarko E, Ikumapayi UN, Secka O, Betts M, Bradbury R, Wegmüller R, Lawal B, Saha D, Hossain MJ, Prentice AM, Kampmann B, Anderson S, Dalessandro U, Antonio M. Salmonella Infections in The Gambia, 2005-2015. Clin Infect Dis 2016; 61 Suppl 4:S354-62. [PMID: 26449952 DOI: 10.1093/cid/civ781] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There are large data gaps in the epidemiology of diseases caused by Salmonella enterica in West Africa. Regional surveillance of Salmonella infections is necessary, especially with the emergence and spread of multidrug-resistant clones. METHODS Data on Salmonella isolated from various clinical specimens from patients from across The Gambia were collected and analyzed retrospectively from 2005 to April 2015. Antibiotic sensitivity testing of Salmonella isolates was performed by disk diffusion method. Serotyping and serogrouping of Salmonella isolates was performed using standard microbiology techniques. RESULTS Two hundred three Salmonella isolates were isolated from 190 patients: 52% (106/203) from blood and 39% (79/203) from stool specimens. Salmonella was also isolated from urine, aspirates, cerebrospinal fluid, wounds, and abscesses. The prevalence of Salmonella in blood cultures was 0.8% (106/13,905). Of the serotyped salmonellae, 14% (21/152) were Salmonella enterica serovar Typhi, whereas 86% (131/152) were serovars other than Typhi (nontyphoidal Salmonella). Of the 102 typed NTS isolates, 40% (41) were Salmonella enterica serovar Typhimurium, 10% (10) were Salmonella enterica serovar Enteritidis, and 3% (3) were Salmonella enterica serovar Arizonae. Overall, 70% (142/203) of the salmonellae were pansusceptible. Multidrug resistance was found in 4% (9/203) of the isolates, 3 of which were Salmonella Enteritidis. CONCLUSIONS Salmonellae are associated with a wide spectrum of invasive and noninvasive infections across all ages in The Gambia. There is evidence of multidrug resistance in salmonellae that warrants vigilant monitoring and surveillance.
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Affiliation(s)
| | | | - Helen Nabwera
- Medical Research Council Unit, Fajara International Nutrition Group, Medical Research Council Unit, Banjul, The Gambia
| | | | | | | | | | - Richard Bradbury
- School of Medical and Applied Sciences, Central Queensland University, North Rockhampton, Australia
| | - Rita Wegmüller
- Medical Research Council Unit, Fajara International Nutrition Group, Medical Research Council Unit, Banjul, The Gambia
| | | | | | | | - Andrew M Prentice
- Medical Research Council Unit, Fajara International Nutrition Group, Medical Research Council Unit, Banjul, The Gambia
| | | | | | - Umberto Dalessandro
- Medical Research Council Unit, Fajara Institute of Tropical Medicine, Antwerp, Belgium Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine
| | - Martin Antonio
- Medical Research Council Unit, Fajara Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine Microbiology and Infection Unit, Warwick Medical School, University of Warwick, Coventry, United Kingdom
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11
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Kohlmann R, Nefedev A, Kaase M, Gatermann SG. Community-acquired adult Escherichia coli meningitis leading to diagnosis of unrecognized retropharyngeal abscess and cervical spondylodiscitis: a case report. BMC Infect Dis 2015; 15:567. [PMID: 26654107 PMCID: PMC4676899 DOI: 10.1186/s12879-015-1310-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 12/03/2015] [Indexed: 01/17/2023] Open
Abstract
Background Escherichia coli is a rare cause of community-acquired meningitis in adults unless predisposing factors are present (e.g., previous penetrating cranio-cerebral injury or neurosurgery, immunosuppression, chronic alcoholism, history of cancer, diabetes mellitus, advanced age). Case presentation We describe the case of a 53-year-old woman, resident in Germany, suffering from community-acquired bacterial meningitis caused by CTX-M-9 type extended spectrum β-lactamase producing Escherichia coli. Because typical predisposing factors were not apparent, pathogen identification resulted in expanded diagnostics to exclude a distant or contiguous primary focus. By magnetic resonance tomography, a previously unrecognized large retropharyngeal abscess with cervical spondylodiscitis was detected. In retrospect, the patient had complained about neck pain for a few weeks prior to meningitis onset, but the symptoms were interpreted as being related to a herniated disk. Meningitis and osteomyelitis resolved completely under surgical treatment and meropenem therapy. Conclusion In case of adult Escherichia coli meningitis, underlying diseases should always be carefully excluded, especially if predisposing factors are not apparent.
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Affiliation(s)
- Rebekka Kohlmann
- Department of Medical Microbiology, Ruhr-University Bochum, Universitaetsstrasse 150, 44801, Bochum, Germany. .,Institute of Medical Laboratory Diagnostics (IML) Bochum GmbH, Castroper Strasse 45, 44791, Bochum, Germany.
| | - Andrey Nefedev
- Department of Neurology, Evangelisches Krankenhaus Castrop-Rauxel, Grutholzallee 21, 44577, Castrop-Rauxel, Germany.
| | - Martin Kaase
- Department of Medical Microbiology, Ruhr-University Bochum, Universitaetsstrasse 150, 44801, Bochum, Germany.
| | - Sören G Gatermann
- Department of Medical Microbiology, Ruhr-University Bochum, Universitaetsstrasse 150, 44801, Bochum, Germany. .,Institute of Medical Laboratory Diagnostics (IML) Bochum GmbH, Castroper Strasse 45, 44791, Bochum, Germany.
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