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Anthrax meningoencephalitis complicated with brain abscess - A case report
Corneliu Petru Popescu1, Mihaela Zaharia1, Maria Nica1
1Carol Davila University of Medicine and Pharmacy, Bucharest, Romania; Dr Victor Babes Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania.
Abstract:
Bacillus anthracis is a sporulating gram-positive rod whose main route of entry into the human body is cutaneous. Anthrax meningitis is usually fulminant and fatal. We present here a successfully treated case of anthrax meningoencephalitis complicated with brain abscess. The patient was a shepherd, with disease onset 7 days prior to hospital admission with fever, chills, occipital headache, and vertigo, followed by right hemiplegia, motor aphasia, agitation and coma. He had cutaneous lesions with black eschar on the limbs, which was a clue (along with his occupation), for diagnosis suspicion. The polymerase chain reaction for B. anthracis DNA was positive in both cerebrospinal fluid and cutaneous lesions. The cerebrospinal fluid was compatible with bacterial meningitis without being haemorrhagic. Magnetic resonance imaging showed meningeal enhancement and multiple intraparenchymal heterogeneous lesions with an important haemorrhagic component in the left parietal lobe, surrounded by vasogenic oedema with maintenance, 22 days later, of the left parietal lobe lesion, having a ring contrast enhancement and a central diffusion restriction, compatible with an abscess. From admission, he was intensively treated with combined large-spectrum antibiotics; this could be the most valuable factor in the successful outcome.
Insights
This case study details a successful treatment for anthrax meningoencephalitis, a rare and often fatal condition. Early diagnosis and intensive antibiotic therapy were key to the patient
Area of Science:
- Infectious Diseases
- Neurology
- Microbiology
Background:
- Bacillus anthracis, a gram-positive bacterium, typically enters the human body via cutaneous exposure.
- Anthrax meningitis is a severe complication, often leading to fatal outcomes due to its fulminant nature.
Observation:
- A shepherd presented with symptoms including fever, headache, and neurological deficits, alongside characteristic cutaneous black eschar lesions.
- Polymerase chain reaction confirmed Bacillus anthracis DNA in cerebrospinal fluid and skin lesions.
- Neuroimaging revealed meningeal enhancement and intraparenchymal lesions with hemorrhagic components, evolving into a brain abscess.
Findings:
- The cerebrospinal fluid analysis indicated bacterial meningitis without hemorrhage.
- Magnetic resonance imaging demonstrated progressive changes consistent with meningoencephalitis and subsequent brain abscess formation.
- Successful treatment was achieved through intensive, combined broad-spectrum antibiotic therapy initiated upon admission.
Implications:
- This case highlights the possibility of successful treatment for anthrax meningoencephalitis, even with brain abscess complications.
- Prompt diagnosis, supported by molecular testing and characteristic clinical/radiological findings, is crucial.
- Intensive antibiotic management appears to be a critical factor in achieving favorable outcomes for this rare neurological infection.
