Document Detail


Pneumocephalus in neonatal meningitis: diffuse, necrotizing meningo-encephalitis in Citrobacter meningitis presenting with pneumatosis oculi and pneumocephalus.
MedLine Citation:
PMID:  15215013     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
INTERVENTIONS: Ventilatory support, fluid resuscitation, and continuous venovenous hemofiltration were provided in view of multiple system failure. Despite effective antibiotic therapy and supportive management, the patient died with worsening accumulation of gas within the brain, resulting in brainstem death.
RESULTS: Computed tomographic images were characteristic of diffuse necrotizing meningo-encephalitis. Postmortem examination showed friable brain tissue with venous infarction and extensive gas accumulation. Citrobacter koseri was identified from the blood and cerebrospinal fluid cultures.
CONCLUSION: This case re-emphasises the importance of C. koseri as both a community-acquired and nosocomial neonatal pathogen. Radiologic evidence suggestive of diffuse necrotizing meningo-encephalitis in combination with pneumocephalus and pneumatosis oculi in Citrobacter infections has never been described before. Diagnostic imaging with computed tomographic scanning of the brain and initiation of broad-spectrum antibiotics with good penetration into cerebrospinal fluid are indicated as soon as infection with Citrobacter species is suspected clinically, with appearance of pneumatosis oculi as a rare, late finding.
Authors:
Suneel Kumar Pooboni; Sujeev Kumar Mathur; Anthony Dux; John Hewertson; Sanjiv Nichani
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies     Volume:  5     ISSN:  1529-7535     ISO Abbreviation:  Pediatr Crit Care Med     Publication Date:  2004 Jul 
Date Detail:
Created Date:  2004-06-24     Completed Date:  2004-10-07     Revised Date:  2011-01-11    
Medline Journal Info:
Nlm Unique ID:  100954653     Medline TA:  Pediatr Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  393-5     Citation Subset:  IM    
Affiliation:
Paediatric Critical Care Unit, Glenfield Hospital, Leicester, UK.
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MeSH Terms
Descriptor/Qualifier:
Citrobacter koseri / isolation & purification*
Enterobacteriaceae Infections / complications*,  diagnosis
Fatal Outcome
Fluid Therapy
Hemofiltration
Humans
Infant, Newborn
Male
Meningoencephalitis / diagnosis,  microbiology*
Necrosis
Pneumocephalus / diagnosis,  etiology*
Respiration, Artificial

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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