Neuroinvasive Infection from O117:K52:H-Escherichia colifollowing Acute Pyelonephritis

Abstract

Spontaneous or nosocomial Escherichia coli meningitis remains rare in healthy adults but is still carrying a high mortality rate despite adapted antimicrobial treatment for susceptible strains. A 39-year-old woman was admitted to the hospital with severe subarachnoid haemorrhage complicated by acute hydrocephalus. On hospital day 10, she developed Streptococcus anginosus septicaemia and urinary tract infection due to a multisensitive strain of E. coli. This infection was successfully controlled by antimicrobial therapy. As a late complication in the neurosurgical ward (day 39), she developed fever, alteration of consciousness, and shock, leading to the diagnosis of bacterial meningitis. The culture of blood, cerebrospinal fluid, and urine grew positive for a multisensitive E. coli. The strain was identified as O117:K52:H, a serotype that was until now never associated with acute meningitis or brain abscesses. The source appeared to be the urinary tract with the demonstration of acute pyelonephritis. The patient died on day 94 from delayed complications of multiple brain abscesses.

Acute meningitis and emphysematous pyelonephritis due to extended-spectrum beta-lactamase-producing E. coli

“…Cromlin et al reported a case of O117:K52: H E. coli meningitis and multiple brain abscesses with the demonstration of acute pyelonephritis as the primary source. The patient died from complications [9]. Common risk factors for GNB meningitis include cirrhosis, alcoholism, malignancy, diabetes mellitus, immunosuppressive drugs and HIV infection [10].…”