Dados do Trabalho
NEONATAL MENINGITIS AND INTRACRANIAL EMPYEMA DUE TO PROTEUS MIRABILIS: A CASE REPORT
Apresentação do caso
Term Newborn, male, small for gestational age, borned by cesarean delivery because of acute fetal distress and gastroschisis, was submitted to surgery immediately after birth on 01/14/23. On 01/27/23 the newborn was presented with hyperthermia and apnea, resulting in investigation for sepsis. Blood and liquor cultures were positive for Proteus mirabilis and sensitive to fourth generation cephalosporins. The baby was submitted to transfontanellar ultrasound, that showed signs of supratentorial ependymitis with ventriculomegaly on 02/02/23, causing the neonatologists to change the therapy for carbapenem and aminoglycoside. The patient, however, evolved with seizures, hyperthermia and apnea. On 03/03/23 was submitted to magnetic resonance imaging that showed empyemas in the middle and posterior cranial fossa. Medical assistant decided to continue the antimicrobial therapy and to not submit the baby to a surgery intervention. The baby evolved with negative cultures and with improvement of symptoms, with hospital discharge on 04/12/23 (3 months old).
Neonatal bacterial meningitis is a devastating infection, associated with many neurological complications, such as seizures, encephalopathy and intracranial empyema. The most common pathogens are Group B Streptococcus (GBS) and Escherichia coli, but the Proteus mirabilis is considered a pathogen with great morbidity and mortality. Proteus mirabilis is a Gram-negative bacteria, more commonly associated with urinary Tract infections, that corresponds to 4% of meningitis cases and it is associated with cerebral empyemas and complications.
Neonatal meningitis due to Proteus mirabilis is a potential life threatening condition. This case report is relevant considering the presentation, the unusual pathogen and the outcomes. Patients with these findings should remain in follow-up considering the potential complications post acute phase of the infection.
Referências (se houver)
1. Armbruster CE, Mobley HLT, Pearson MM. Pathogenesis of Proteus mirabilis Infection. EcoSal Plus. 2018 Feb;8(1):10.1128/ecosalplus.ESP-0009-2017. doi: 10.1128/ecosalplus.ESP-0009-2017. PMID: 29424333; PMCID: PMC5880328.
2. Chu SM, Hsu JF, Lee CW, Lien R, Huang HR, Chiang MC, Fu RH, Tsai MH. Neurological complications after neonatal bacteremia: the clinical characteristics, risk factors, and outcomes. PLoS One. 2014 Nov 3;9(11):e105294. doi: 10.1371/journal.pone.0105294. PMID: 25364821; PMCID: PMC4217713.
3. Juyal D, Rathaur VK, Sharma N. Neonatal meningoventriculitis due to proteus mirabilis - a case report. J Clin Diagn Res. 2013 Feb;7(2):369-70. doi: 10.7860/JCDR/2013/5146.2772. Epub 2012 Dec 24. PMID: 23543669; PMCID: PMC3592316.
Meningitis, Empyema, Neonatal Sepsis
Fonte de Fomento (se houver)
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Sem conflito de interesses.
COMPLEXO HOSPITALAR DA UNIVERSIDADE FEDERAL DO CEARÁ - CH-UFC - Ceará - Brasil
ANNA JAMYLLE DIAS BORGES LEAL, REBECA MONTALVERNE BARRETO DE PAULA PESSOA, KATHIANE MOREIRA DE FREITAS MARTINS, GABRIELLE GOMES DE SOUSA, PRISCILA MAGALHÃES DE MEDEIROS, CLAUDIANE CAVALCANTI PESSOA PASCOAL