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Citrobacter diversus and neonatal brain abscess.

M W Kline¹, S L Kaplan

¹Myers-Black Section of Pediatric Infectious Diseases, Baylor College of Medicine and Texas Children's Hospital, Houston 77030.

Pediatric Neurology

|May 1, 1987

Summary

Citrobacter diversus meningitis in infants can lead to persistent brain abscesses. Effective treatment may require antibiotics targeting phagocytes and surgical drainage, alongside imaging for diagnosis.

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Area of Science:

Neonatal infectious diseases
Pediatric neurology
Clinical microbiology

Background:

Citrobacter diversus is a rare but serious cause of neonatal meningitis.
Brain abscesses are a known complication of bacterial meningitis.
Early diagnosis and effective treatment are crucial for favorable outcomes in neonatal meningitis.

Observation:

A 23-day-old infant presented with apnea and was diagnosed with Citrobacter diversus meningitis and brain abscess.
The organism persisted in the brain abscess fluid for over four weeks despite appropriate antibiotic treatment.
Cranial computed tomography revealed persistent frontal lobe radiolucencies and midline shift even after antibiotic therapy completion.

Findings:

Citrobacter diversus meningitis can result in persistent brain abscesses refractory to standard antibiotic therapy.
Antibiotic therapy may need to penetrate phagocytic cells for effective treatment of C. diversus brain abscesses.
Surgical drainage may be a necessary component of treatment for C. diversus brain abscesses.

Implications:

Cranial computed tomography is essential for all infants diagnosed with Citrobacter diversus meningitis due to the high prevalence of brain abscesses.
Treatment strategies for C. diversus meningitis and brain abscess should consider antibiotics active within phagocytes and surgical intervention.
This case highlights the challenges in treating C. diversus brain abscesses and underscores the need for advanced diagnostic and therapeutic approaches.

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