Proteus mirabilis meningitis: report of two cases treated with ampicillin

Cerebral abscess complicating Proteus mirabilis meningitis in a newborn infant

Neonatal bacterial meningitis is associated with high morbidity and mortality, especially when complicated by intracranial abscesses. The authors report the case of an 11-day-old female with Proteus mirabilis meningitis complicated by an asymptomatic brain abscess. With this report, the authors illustrate the importance of surveillance neuroradiologic imaging in patients with Proteus meningitis.

Central nervous system infection caused by Morganella morganii

Central nervous system (CNS) infection with Morganella morganii is very rare. We describe a 38-year-old female patient with frontal brain abscess caused by M morganii who was unsuccessfully treated. We also review all reported cases of Morganella CNS infections with an emphasis on treatment modalities and outcomes. Aggressive surgical management and appropriate antimicrobial therapy can lead to cure, but the mortality rate for these infections remains high.

Antimicrobial penetration into cerebrospinal fluid

The complex physiology of the blood-brain barrier and the characteristics of an antimicrobial which govern its distribution into the brain are poorly understood. Likewise, available data regarding CSF antimicrobial concentrations after extra-CNS administration, as tabulated in this review, are inadequate. Because of the potentially dire consequences that result from inappropriately treated CNS infections, large cooperative studies using standardized methodology are needed. Suggestions for such methods are outlined.

Gram-negative bacillary meningitis

All cases of unusual types of gram-negative bacillary meningitis in a university hospital over a five year period were retrospectively analyzed. These patients comprised 4.2 per cent of cases of bacterial meningitis among all patients, 69 per cent of neurosurgical cases and 42 per cent of neonatal cases. The over-all mortality was 40.3 per cent. The two most common bacterial isolates were Escherichia coli in patients younger than one year and Klebsiella species in patients above that age. Infection may be acquired at birth or at the time of surgery, or may be secondary to spread of infection from other body sites. Gram-negative bacillary meningitis is a nosocomial infection and this diagnosis should be suspected in patients in whom central nervous system infection develops in the hospital.

A prospective search for congenital dermal abnormalities of the craniospinal axis

Nineteen-hundred and ninety-seven consecutive term newborn infants were examined for cutaneous abnormalities of the craniospinal axis. Fifty-eight of the neonates (3%) had one or more abnormalities. The major findings included 28 (1.4%) deep dimples; 23 (1.2%) presumed sinuses; six (0.3%) skin tags,and one nodular mass. Fifty children were seen in follow-up at 4 to 12 months; in 40 infants the initial major finding persisted unchanged. Surgery has been performed on five children. One dermal sinus was found to terminate at the dura, three sinuses terminated at the coccyx, and a skin tag was associated with a fibrous band that extended to the coccyx. The management of congenital dermal sinuses is discussed.