Neuroinvasive Infection from O117:K52:H-Escherichia coli following Acute Pyelonephritis

Area of Science:

• Neurology
• Infectious Diseases
• Microbiology

Background:

• Spontaneous or nosocomial Escherichia coli (E. coli) meningitis is uncommon in healthy adults but associated with high mortality.
• Early management involves antimicrobial therapy tailored to susceptible strains.

Observation:

• A 39-year-old woman with subarachnoid hemorrhage and hydrocephalus developed E. coli sepsis and urinary tract infection.
• The patient later presented with fever, altered consciousness, and shock, indicative of bacterial meningitis.
• Blood, cerebrospinal fluid, and urine cultures confirmed a multisensitive E. coli strain, identified as O117:K52:H.

Findings:

• The identified E. coli serotype O117:K52:H was previously unassociated with meningitis or brain abscesses.
• The urinary tract, specifically acute pyelonephritis, was identified as the source of the E. coli infection.
• The patient succumbed to delayed complications, including multiple brain abscesses, 94 days after admission.

Implications:

• This case expands the known clinical spectrum of E. coli meningitis, particularly concerning the O117:K52:H serotype.
• It underscores the importance of considering urinary tract infections as a potential source for severe neurological infections.
• Highlights the critical need for vigilance in diagnosing and managing rare complications of E. coli infections in neurosurgical patients.