Multiple Brain Abscesses Complicating Enterobacter Cloacae Sepsis in a Preterm Neonate with Atypical MRI Appearance: A Case Report

Document Type : case report

Authors

1 Al-Quds University, Faculty of Medicine, Jerusalem, State of Palestine

2 Department of Neonatal and Intensive Care, Palestine Red Crescent Society Hospital, Hebron, Palestine

3 Department of Neurosurgery, Al-Ahli Hospital, Hebron, Palestine

4 Department of Diagnostic Imaging, Institute of Mother and Child, Warsaw, Poland

Abstract

Multiple brain abscesses in neonates are extremely rare and occur as an unusual complication of bacterial meningitis or sepsis. There are many bacterial pathogens reported to cause brain abscesses in newborns; however, brain abscess caused by Enterobacter cloacae has rarely been described previously in neonates and only a few reports exist in English literature. After 4 weeks in the neonatal intensive care unit, a preterm neonate developed multiple brain abscesses as a complication of E. cloacae sepsis which were revealed on TFU and confirmed on MRI. Consequently, a limited craniotomy was performed for the biggest abscess for evacuation of pus and followed by aspiration of other abscesses.

Keywords

References

  1. Renier D, Flandin C, Hirsch E, Hirsch JF. Brain abscesses in neonates. J Neurosurg.1988; 69:877–82.
  2. Acolet D, Ahmet Z, Houang E, Hurley R, Kaufmann ME. Enterobacter cloacae in a neonatal intensive care unit: account of an outbreak and its relationship to use of third generation cephalosporins. J Hosp Infect. 1994; 28:273–86.
  3. Sutton DL, Ouvrier RA. Cerebral abscess in the under 6 month’s age group. Arch Dis Child. 1983; 58:901–5.
  4. Straussberg R, Harel L, Amir J. Long-term outcome of neonatalCitrobacter koseri (diversus) meningitis treated with imipenem/meropenem and surgical drainage. Infection. 2001; 29:280–2.
  5. Martínez-Lage JF, Martínez-Lage Azorín L, Almagro MJ,Bastida ME, Reyes S, Tellez C. Citrobacter koseri meningitis:a neurosurgical condition? Eur J Paediatr Neurol. 2010; 14:360–3.
  6. Krajewski R, Stelmasiak Z: Brain abscess in infants. Childs Nerv Syst. 1992; 8:279–80.
  7. Dealers. Enterobacter cloacae infection and colonization in a neonatal intensive care unit. J Hosp Infect. 2002; 52:72e73.
  8. Lee NC, Chen SJ, Tang RB, Hwang BT. Neonatal bacteremia in a neonatal intensive care unit: analysis of causative organisms and antimicrobial susceptibility. J Chin Med Assoc. 2004; 67:15−20.
  9. Chin HN,Lee ML, Yu WK, Chen HN, Lee ML, Yu WK, Lin YW, Tsao LY: Late-onset Enterobacter cloacae sepsis in very-low-birth-weight neonates: experience in a medical center, PediatrNeonatol. 2009; 50:3.
  10. Graham DR, Band JD. Citrobacterdiversus brain abscess and meningitis in neonates. J Am Med Assoc. 1981; 245:1923e5.
  11. Doran TI. The role of Citrobacter In clinical disease of children: review. Clin Infect Dis. 1999; 28:384e94.
  12. Stallworth L, Mani C, Murry D. Index of suspicion in the nursery. Neoreviews 2005; 6:e436–8.
  13. Vartzelis G, Theodoridou M, Daikos GL, Delagrammaticas H, Syriopoulou VP. Brain abscesses complicating Staphylococcus aureus sepsis in a premature infant. Infection. 2005; 33(1):36–8.
  14. Carpenter J, Stapleton S, Holliman R. Retrospective analysis of 49 cases of brain abscess and review of the literature. Eur J ClinMicrobiol Infect Dis. 2007; 26:1-11.
  15. Meves SH, Schroder A, Muhs A, Postert T, Federlein J, Buttner T: Distribution of artificially-produced microembolic signals into the cerebral circulation. Ultrasound Med Biol. 2001; 27:285–27.
  16. Regev RH, Dolfin TZ, Zamir C: Multiple brain abscesses in a premature infant: complication of Staphylococcus aureus sepsis. Acta Paediatr. 1995; 84:585-7.
  17. Lechowicz M, Dąbek K, Majewska U, Bekiesińska-Figatowska M, Boryszewska-Kornacka MK, Bokiniec R. Multiple Brain Abscesses Caused by Citrobacter Koseri in a Preterm Neonate – Case Report. Pol J Radiol. 2017; 82:837-41.
  18. Muccio CF, Caranci F, D'Arco F, Cerase A, De Lipsis L, Esposito G, Tedeschi E, Andreula C. Magnetic resonance features of pyogenic brain abscesses and differential diagnosis using morphological and functional imaging studies: a pictorial essay. J Neuroradiol. 2014; 41(3):153-67.
  19. Raz E, Zagzag D, Saba L, Mannelli L, Di Paolo PL, D'Ambrosio F, Knopp E. Cyst with a mural nodule tumor of the brain. Cancer Imaging. 2012; 12:237-44.
  20. Lu CH, Chang WN, Lui CC. Strategies for the management of bacterial brain abscess. J ClinNeurosci. 2006; 13(10):979–85.
  21. Chacko AG, Chandy MJ. Diagnostic and staged stereotactic aspiration of multiple bihemispheric pyogenic brain abscesses. Surg Neurol. 1997; 48:278-82.
  22. McPherson C, Gal P, Ransom JL. Treatment of Citrobacter koseri infection with ciprofloxacin and cefotaxime in a preterm infant. Ann Pharmacother. 2008; 42:1134–8.
Journal of Pediatric Perspectives
Volume 10, Issue 8
August 2022
Pages 16606-16613

Files

Share

How to cite

Statistics