Multiple brain abscesses due to Enterobacter cloacae in an immune-competent child

Abstract Brain abscesses due to Enterobacteriaceae in immune-competent children are rare, and those due to Enterobacter cloacae are even rarer. We report an interesting case of community-acquired E. cloacae neuroinfection resulting in multiple brain abscesses in a young child with no underlying risk...

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Bibliographic Details
Published in:Journal of infection and public health 2017-09, Vol.10 (5), p.674-677
Main Authors: Saini, Arushi Gahlot, Rathore, Vinay, Ahuja, Chirag Kumar, Chhabra, Rajesh, Vaidya, Pankaj C, Singhi, Pratibha
Format: Article
Language:English
Subjects:
Brain - pathology
Brain abscess
Brain Abscess - diagnostic imaging
Brain Abscess - immunology
Brain Abscess - microbiology
Carbapenems
Child
Community-Acquired Infections - diagnostic imaging
Community-Acquired Infections - microbiology
Enterobacter
Enterobacter cloacae
Enterobacteriaceae Infections - diagnostic imaging
Enterobacteriaceae Infections - immunology
Enterobacteriaceae Infections - microbiology
Enterobacteriaceae Infections - physiopathology
Humans
Infectious Disease
Internal Medicine
Magnetic Resonance Imaging
Male
Neuroinfection
Pyogenic
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Summary:Abstract Brain abscesses due to Enterobacteriaceae in immune-competent children are rare, and those due to Enterobacter cloacae are even rarer. We report an interesting case of community-acquired E. cloacae neuroinfection resulting in multiple brain abscesses in a young child with no underlying risk-factors. A 10 year-old-boy presented with low-grade fever, headache, neck pain and progressive deterioration of sensorium. On examination, he was conscious but drowsy with photophobia, normal fundii, meningeal signs, mild hypertonia, brisk muscle stretch reflexes and extensor plantar responses. Magnetic resonance imaging of brain showed bilateral, multiple pyogenic abscesses. Culture of the abscess material aspirated at the time of surgical drainage showed growth of E. cloacae. He received intravenous imipenem for 18 weeks guided by clinical and radiological response. A pragmatic approach combining early surgical drainage, targeted antimicrobial therapy and patient-tailored duration based on the clinico-radiological response is needed in such difficult cases.
ISSN:1876-0341
1876-035X
DOI:10.1016/j.jiph.2017.03.008