Pseudomonous putida meningitis in a healthy adult

Abstract

E3V4M6 on the Glasgow Coma Scale) and slight neck rigidity were present. Neurological and general findings showed no other abnormality. Laboratory data on admission were erythrocyte sedimentation rate 109 mm/1h; white blood cells (WBC) 11,170/mm 3 ; and C-reactive protein (CRP) 6.3 mg/dl. Other laboratory tests, including HbA1c and urine analysis, were normal. HIV antibody was negative. Computerized brain tomography (CT) showed slight brain edema. The open pressure was raised to 300 mmH 2 O on lumbar puncture on admission. Her cerebrospinal fluid (CSF) was cloudy with 1833/mm 3 WBC (78.5 % polymorphonuclear cells), 44 mg/dl glucose (simultaneous blood sugar 130 mg/dl), and 344 mg/dl protein.A chest radiograph and cardioechograph were normal. Her CT of the abdominal, chest, and cervical regions revealed no focus of infection or malignancy. No CSF leakage or sinusitis was found in otolaryngological medical examinations. We immediately started the antibiotics ceftriaxone and vancomycin with dexamethazone, the standard therapy for acute bacterial meningitis. Gram staining of her CSF showed gram negative rods. Because on hospital day two a culture grew the pseudomonas genus, she was placed on ceftazidime and gentamycin. Later, the P. putida found in both her CSF and blood cultures was susceptible to ceftazidime, gentamycin, meropenem and imipenem. Her consciousness slowly improved, becoming clear on hospital day four. Her laboratory data for hospital day two showed a WBC count of 12090/ mm 3 and a CRP of 17.6 mg/dl. In the CSF study performed on the same day, her WBC count was 7753/mm 3 . Subsequent blood and CSF tests showed improvement, and no bacteria were detected in her CSF. Because drug-induced

The clinical characteristics of adult bacterial meningitis caused by non‐Pseudomonas(Ps.)aeruginosa Pseudomonasspecies: A clinical comparison withPs. aeruginosameningitis

“…The clinical features and therapeutic outcomes of the 11 NPAP ABM cases are listed in Table 2 (Cases 1–11). The clinical features and therapeutic outcomes of the 11 NPAP ABM cases collected from the literature [7–16] are also listed in Table 2 (Cases 12–22) and Table 3. Therefore, a total of 22 cases with NPAP ABM were included in the analysis.…”

“…The underlying conditions of the patients with ABM caused by Ps. stutzeri infection varied considerably, with two not having any underlying condition [10,11] and the other five having serious medical and/or postneurosurgical conditions including alcoholism, chronic lung disease, bladder cancer with metastasis and craniectomy, human immunodeficiency virus infection, Crohn's disease undergoing vedolizumab treatment and connective tissue disease. In addition to the differences in clinical features, the mortality rate was higher in the patients with ABM caused by Ps.…”

“…This study was approved by the hospital's Ethical Committee (IRB 201600841B0). In addition, 11 cases of ABM caused by NPAP infection reported in the literature were also collected [7–16]. These 11 enrolled cases were identified through the searching system PubMed (https://www.ncbi.nlm.nih.gov/pubmed/) by using the keywords: Pseudomonas meningitis, Pseudomonas ventriculitis, and Pseudomonas pachymeningitis.…”

“…aeruginosa Pseudomonas (NPAP) ABM collected during a study period of 30 years (1986–2015). To improve the analysis, we also included 11 other cases of NPAP ABM reported in the literature [7–16]. The overall study results were also compared with the clinical characteristics of Ps.…”