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Citrobacter meningitis in adults
1Department of Neurology, Chang Gung Memorial Hospital and Chang Gung Medical College, Taipei, Taiwan.
Abstract:
Citrobacter meningitis is an uncommon infection of neonates and young children. It is rarely seen in adults. We describe a 46-year-old man with a mixed bacterial meningitis caused by C. diversus and Klebsiella oxytoca and a 64-year-old woman with C. freundii meningitis. Review of the English-language literature revealed only 2 adult patients with C. diversus meningitis and another 2, with C. freundii meningitis. The ages of these 6 aforementioned patients ranged from 31 to 84 years. Multiple facial fractures, neurosurgical procedures, alcoholism and diabetes mellitus were predisposing conditions. Among the 5 patients whose outcome was known, antibiotic therapy was successful in 4 but failed in 1. This study emphasizes that almost any of the gram-negative bacilli can cause serious infection of the central nervous system in adults in the proper setting.
Insights
Citrobacter meningitis, rare in adults, can be caused by gram-negative bacilli. This study highlights rare adult cases of Citrobacter diversus and Citrobacter freundii meningitis, emphasizing potential risks in specific patient groups.
Area of Science:
- Infectious Diseases
- Neurology
- Microbiology
Background:
- Citrobacter meningitis is typically observed in neonates and young children.
- Adult cases of Citrobacter meningitis are exceptionally rare in medical literature.
Observation:
- This report details two adult patients diagnosed with Citrobacter meningitis.
- A 46-year-old male presented with mixed bacterial meningitis involving Citrobacter diversus and Klebsiella oxytoca.
- A 64-year-old female was diagnosed with Citrobacter freundii meningitis.
Findings:
- A literature review identified only four previously reported adult cases of Citrobacter diversus or Citrobacter freundii meningitis.
- Predisposing factors in adult patients included facial fractures, neurosurgery, alcoholism, and diabetes mellitus.
- Antibiotic therapy was effective in four out of five reported adult cases with known outcomes.
Implications:
- This study underscores that various gram-negative bacilli can cause severe central nervous system infections in adults under specific circumstances.
- Clinicians should consider Citrobacter species in the differential diagnosis of meningitis in adult patients with relevant predisposing conditions.