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Mixed bacterial and fungal meningitis in a neonate
Abstract:
Mixed infections of the central nervous system occurring in children without underlying neurological disease may be more frequent than previously suspected. In this case report, a neonate whose cerebrospinal fluid culture at 24 hours showed group B streptococcus only, was found on postmortem examination at six days of age to have disseminated candidiasis with cerebral abscesses. The degree of systemic involvement in this newborn suggested intra-uterine acquired candidiasis. Early diagnosis of polymicrobic infections is difficult, but this case suggests it should be considered in patients not responding to antibiotic therapy.
Insights
Central nervous system infections in children may be common. A neonate with only group B streptococcus initially was found to have disseminated candidiasis and cerebral abscesses, suggesting intrauterine infection.
Area of Science:
- Pediatric Infectious Diseases
- Neonatal Neurology
- Mycology
Background:
- Mixed central nervous system (CNS) infections in children without prior neurological conditions are potentially underdiagnosed.
- Prompt diagnosis and treatment are crucial for managing CNS infections in neonates.
Observation:
- A case report details a neonate initially presenting with only group B Streptococcus in cerebrospinal fluid.
- Postmortem examination revealed disseminated candidiasis with cerebral abscesses in the six-day-old infant.
Findings:
- The extensive systemic candidiasis suggested an intrauterine origin.
- Initial antibiotic therapy was ineffective, highlighting diagnostic challenges in polymicrobial CNS infections.
Implications:
- This case underscores the importance of considering fungal infections, particularly candidiasis, in neonates with suspected or treatment-refractory CNS infections.
- Early recognition of polymicrobial CNS infections is critical for appropriate management and improved outcomes in neonates.