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Relapse of Neonatal Escherichia coli Meningitis: Did We Miss Something at First?
Nadja H Vissing1, Mette B Mønster1, Sannie Nordly2
1Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark.
Abstract:
Relapse of neonatal meningitis is most commonly caused by Escherichia coli. Management to prevent relapse varies and evidence is limited. We present four cases of relapsing neonatal E. coli meningitis in Denmark in 2016-2017 and review the current literature on this subject. During the primary episodes, our patients received cephalosporin for 3 weeks and gentamicin for the first 3 days. The only identified risk factor was delayed CSF sterilization in three of four cases and no repeated lumbar puncture. Relapse occurred after 2-28 days; one case with ventriculitis and one with empyema. Relapses were treated for 6-14 weeks with monotherapy. No children had an underlying disease predisposing to E. coli meningitis. There is generally a trend towards reducing invasive procedures, e.g., lumbar puncture and the length of intravenous antibiotics in pediatric infectious diseases, but our cases highlight a condition where the opposite might be needed.
Insights
Relapsing neonatal meningitis, often caused by Escherichia coli, requires careful management. These cases suggest longer antibiotic treatment and potentially more diagnostic procedures may be needed to prevent recurrence.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Pediatric Neurology
Background:
- Neonatal meningitis poses significant risks, with relapses complicating treatment.
- Escherichia coli is a primary pathogen in neonatal meningitis, and relapse management strategies are not well-established.
Observation:
- Four cases of relapsing neonatal Escherichia coli meningitis occurred in Denmark between 2016-2017.
- Patients received standard initial treatment (cephalosporin and gentamicin), but relapse occurred within weeks.
- Delayed cerebrospinal fluid (CSF) sterilization was noted in most cases, with no repeated lumbar punctures performed.
Findings:
- Relapses presented with varying complications, including ventriculitis and empyema.
- Treatment durations for relapses ranged from 6 to 14 weeks of monotherapy.
- No underlying predisposing conditions were identified in the affected infants.
Implications:
- Current trends favor less invasive procedures and shorter antibiotic courses in pediatrics.
- These findings challenge that trend, suggesting prolonged interventions may be necessary for relapsing neonatal E. coli meningitis.
- Further research into optimal management protocols for preventing recurrent neonatal meningitis is warranted.
