Actinobacillus ureae Meningitis in Pediatrics: A Rare Clinical Case

We report the case of a 12-year-old child with a history of head trauma, followed by two episodes of meningitis caused by Streptococcus pneumonia, then Haemophilus influenza (H. influenzae), and two osteoplasties in a neurosurgery department. Currently presenting with the frank acute meningeal syndrome with deterioration of the general condition. A lumbar puncture revealed cloudy cerebrospinal fluid (CSF), pleocytosis, hypoglycorachia, and hyperproteinorachia. A multiplex polymerase chain reaction (PCR) was negative, while culture on enriched media isolated Actinobacillus ureae (A. ureae), identified by mass spectrometry (VITEK® 2 MS, bioMérieux, France). The antibiogram showed susceptibility to amoxicillin, ceftriaxone, trimethoprim-sulfamethoxazole, and ciprofloxacin. The patient was treated with ceftriaxone for 10 days, leading to a favorable clinical and biological outcome. The literature reports 27 cases of human infection with A. ureae, including 14 cases of meningitis. These cases are often associated with head trauma, neurosurgical procedures, or predisposing factors such as alcoholism and immunosuppression. Diagnosis can be challenging in the absence of pathogen-specific clinical or biological markers; however, advanced techniques such as 16S rRNA sequencing may be helpful when conventional methods fail to identify the pathogen. A. ureae remains susceptible to beta-lactam antibiotics, with penicillin and amoxicillin as the treatments of choice. This case emphasizes the importance of considering A. ureae meningitis in symptomatic patients with a history of head trauma or neurosurgical interventions, stressing the need for early diagnosis and prompt management to improve patient outcomes.