We report the first case of human infection due to Pseudomonas fulva. P. fulva caused acute meningitis following the placement of a drainage system in a 2-year-old female. Additionally, the isolate displayed a VIM-2 carbapenemase in a class 1 integron context.
CASE REPORTA 2-year-old female was brought to our center after 30 days of treatment in another center due to a history of fever, malaise, and partial food rejection. A sample of urine was taken for a bacteriological culture, and empirical treatment with amoxicillin was begun. The urinalysis showed pathological sediment with more than 25 leukocytes per field, pyuria, and bacteriuria. The urinary culture yielded Ͼ10 5 CFU of Proteus penneri per ml. Based on the susceptibility test result, amoxicillin was discontinued and a 1-week course of trimethoprimsulfamethoxazole (TMP-SMX) therapy was prescribed. Since she did not recover, she was hospitalized in the same center for evaluation. After 48 h, she presented a poor general state with signs of meningismus. Therapy with ceftriaxone (150 mg/kg/ day) was started. A computerized axial tomography (CAT) test, performed after lumbar puncture, revealed ventricular dilatation. The cerebrospinal fluid (CSF) cytochemical analysis was normal, and the CSF culture was negative.Due to a torpid evolution and because the patient presented facial paralysis, she was referred to Ricardo Gutierrez Children's Hospital, where a new brain CAT was performed showing progressive hydrocephalus. In order to drain the CSF, an external catheter was placed in the lateral ventricle. A presumptive diagnosis of meningitis with a bad evolution or tuberculous meningitis was made. Empirical treatment with vancomycin (60 mg/kg/day) (intravenous [i.v.]), cefotaxime (220 mg/kg/day) (i.v.), and tuberculostatic drugs (isoniazid, 5 mg/ kg/day; rifampin, 10 mg/kg/day; streptomycin, 15 mg/kg/day; pyrazinamide, 20 mg/kg/day) was started. Since the lumbar puncture was traumatic, CSF chemistry and cell count were not carried out; however, the CSF culture obtained by lumbar puncture (for bacteria, fungi, and mycobacteria) was negative.After 9 days of having the catheter drainage in place, the patient showed no neurological sign improvement. The catheter was changed, and a CSF sample for bacterial culture was taken with negative results. The CSF cell count was 8 leukocytes/mm 3 , and protein and glucose contents were 17 mg/dl and 70 mg/dl, respectively. Vancomycin was suspended, and the patient continued with ceftriaxone, and despite a negative result for the detection of Mycobacterium tuberculosis by PCR, the patient continued on tuberculosis drugs until the culture was finished.As indicated by neurosurgery, a nuclear magnetic resonance test was carried out, showing a lesion that occupied the midbrain and pons consistent with a probable ependymoma.On the eighth day after the new drainage system was placed, the patient was in very poor condition; therefore, internal ventriculoperitoneal shunting and performing a brain biopsy of the mass were considered. A new...