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Enterobacter cloacae: an "ICU bug" causing community acquired necrotizing meningo-encephalitis

Nitin Maheshwari1, Alison Shefler

  • 1Paediatrics, John Radcliffe Hospital, Oxford, UK. nitin023@rediffmail.com

European Journal of Pediatrics
|July 29, 2008
PubMed

Insights

A rare case of community-acquired Enterobacter cloacae meningo-encephalitis rapidly affected a neonate. This highlights the need to consider E. cloacae in severely ill infants presenting from the community.

Area of Science:

  • Neonatal Medicine
  • Infectious Diseases
  • Microbiology

Background:

  • Enterobacter cloacae is a common nosocomial pathogen in neonatal intensive care units (NICUs).
  • Community-acquired infections with E. cloacae are rare, especially invasive forms like meningo-encephalitis.

Observation:

  • A three-week-old neonate presented with a rapidly progressive, severe illness after hospital discharge.
  • Clinical presentation included multi-organ dysfunction and CT findings of severe hypoxic brain injury and herniation.
  • Post-mortem examination confirmed E. cloacae meningo-encephalitis as the cause of death.

Findings:

  • The neonate had no prior critical care exposure, indicating a community-acquired infection.
  • Vertical transmission from mother to neonate is a potential route, given prior reports of intestinal colonization.
  • This case represents a rare instance of severe, community-acquired E. cloacae meningo-encephalitis in an infant.

Implications:

  • E. cloacae should be considered in the differential diagnosis for neonates presenting with severe illness from the community.
  • Prompt and appropriate antimicrobial therapy is crucial for optimizing outcomes in suspected E. cloacae infections.
  • Further investigation into non-nosocomial transmission routes of E. cloacae in neonates is warranted.

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