A rare case of neonatal meningoencephalitis from Paenibacillus thiaminolyticus

Abstract

Paenibacillus infections can be life threatening and are being reported with increasing incidence. There are only a few case reports of infections and are mainly described in patients who are immunocompromised, injection drug users, or those with prosthetic devices. Due to improved testing and identification, it appears that these infections may not be as rare as once perceived. We present a case of a 16-day-old term neonate who presented with status epilepticus and was found to have Paenibacillus thiaminolyticus meningoencephalitis. The patient was successfully treated with a combination of ampicillin and ceftazidime then meropenem. To our knowledge, this is the first reported case of an infant in the United States who survived this serious invasive infection. We also present an option for therapy given the difficulty treating invasive intracranial infections.

Paenibacillus spp infection among infants with postinfectious hydrocephalus in Uganda: an observational case-control study

“…Reports of Paenibacillus infection have been exceedingly rare, 21 , 22 but two cases of P thiaminolyticus brain infections in neonates have been reported in the USA. 23 , 24 We previously reported Paenibacillus in a substantial proportion of infants with postinfectious hydrocephalus with a presumed history of meningitis in Uganda. 8 Our findings of 37 (6%) of 631 cases of Paenibacillus neonatal sepsis is the largest known cluster of cases so far described.…”

HumanPaenibacillusInfections: A Systematic Review with Comparison of Adult and Infant Cases

“…They included two separate Ugandan cohorts previously described by our group 4,5 and 6 single case reports from throughout the United States (Table 2). [38][39][40][41][42][43][44] In contrast to the infections occurring in adults, Paenibacillus infections in infants were caused by only 3 species: P. thiaminolyticus (112/139, 80%), P. alvei (2/139, 1%) and P. dendritiformis (2/139, 1%). An additional 25/139 (18%) were identified only to the genus level.…”

“…One American infant who had severe disease at the time of presentation with seizures, infarction of the thalamus and corona radiata, cystic encephalomalacia, venous sinus thrombosis and ultimately required an endoscopic third ventriculostomy for management of hydrocephalus, was found to have appropriate neurodevelopment at age 18 months after being treated with supplemental thiamine and 6 weeks of intravenous meropenem. 43 It is not clear whether it was the meropenem, the thiamine or the combination of both that was instrumental in achieving this good outcome.…”

“…Because P. thiaminolyticus predominates as the cause of neonatal paenibacilliosis, adjunctive therapies such as thiamine supplementation may also be helpful. 43 Thiamine deficiency has well-described neurologic sequelae (i.e. Wernicke's encephalopathy) which may contribute to the severity of cerebral destruction in neonatal Paenibacillus infections.…”

“…5,61 Meropenem has been successfully used in a few cases. 43 Changes in environmental ecology, whether due to climate change or other factors, may increase human contact with Paenibacillus in the environment. Our work has suggested that neonates with paenibacilliosis are more like to have had non-sterile substances applied to their umbilical stumps.…”