Hospital-Acquired Citrobacter Meningitis Complicated by Pneumocephalus in a Neonate

Area of Science:

• Neonatal Medicine
• Infectious Diseases
• Microbiology

Background:

• Citrobacter koseri is a gram-negative bacillus found in the gut and environment.
• It poses a severe risk to neonates, particularly preterm infants, causing central nervous system infections like meningitis and encephalitis.
• Pneumocephalus, or intracranial gas accumulation, is a rare but often fatal complication.

Purpose of the Study:

• To report a case of a preterm infant with Citrobacter koseri infection.
• To highlight the development of pneumocephalus as a complication.
• To emphasize the importance of infection control in neonatal intensive care units (NICUs).

Main Methods:

• Case report of a preterm female infant admitted to the NICU.
• Clinical monitoring, blood cultures, cranial computed tomography (CT) scan, and autopsy with histology.
• Environmental investigation to identify the source of infection.

Main Results:

• The infant developed sepsis with C. koseri bacteremia, followed by seizures and neurological deterioration.
• Cranial CT revealed extensive pneumocephalus.
• Autopsy confirmed purulent meningitis, meningoencephalitis, cerebral hemorrhages, edema, and ventricular dilation.

Conclusions:

• Citrobacter koseri exhibits high virulence in neonates, leading to severe CNS infections and complications like pneumocephalus.
• Pneumocephalus is a critical and potentially fatal complication in neonatal infections.
• This case underscores the necessity of stringent infection control measures in NICUs to prevent nosocomial transmission.