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Gram-negative bacillary meningitis in an immunocompetent adult
Aniruddha Ray1, Satyaki Basu1, Souradeep Das1
1Internal Medicine, RG Kar Medical College and Hospital, Kolkata, West Bengal, India.
Abstract:
Escherichia coli is a rare cause of community-acquired meningitis comprising about 1% of adult cases. However, it is a common pathogen in neonatal meningitis and in nosocomial setting (especially after penetrating craniocerebral injury or subsequent to neurosurgical procedures). We report a middle-aged woman, who was admitted with features of acute meningitis and subsequent investigations revealed E. coli growth in cerebrospinal fluid culture. The case is distinctive as no additional predisposing risk factors associated with gram-negative bacillary meningitis (traumatic brain injury, neurosurgical procedures, malignancy, immunosuppressive therapy, HIV infection, chronic alcoholism and diabetes) were present. She was treated with intravenous antibiotics as per sensitivity reports and discharged in clinically stable condition, without any residual neurological deficit.
Insights
Escherichia coli meningitis is rare in adults but common in neonates. This case highlights a unique adult meningitis instance caused by E. coli without typical risk factors.
Area of Science:
- Infectious Diseases
- Neurology
- Microbiology
Background:
- Escherichia coli (E. coli) is an uncommon cause of community-acquired meningitis in adults, representing approximately 1% of cases.
- E. coli is a more frequent pathogen in neonatal meningitis and nosocomial meningitis, often linked to specific risk factors.
Observation:
- A middle-aged woman presented with acute meningitis symptoms.
- Cerebrospinal fluid cultures confirmed the presence of E. coli.
Findings:
- The patient lacked common predisposing factors for gram-negative bacillary meningitis, such as traumatic brain injury, neurosurgery, malignancy, or immunosuppression.
- Treatment involved intravenous antibiotics tailored to the isolate's sensitivity profile.
Implications:
- This case underscores the possibility of E. coli meningitis in adults without apparent risk factors.
- Prompt diagnosis and appropriate antibiotic therapy are crucial for favorable outcomes in E. coli meningitis.
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