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Community-acquired Serratia marcescens meningitis
A Peeters1, B Vandercam, C J Sindic
1Department of Neurology, St-Luc University Hospital, Brussels, Belgium.
Abstract:
Serratia marcescens is an unusual cause of community-acquired meningitis in adults. We report a case of S. marcescens meningitis occurring 29 years after a head injury and preceded by 3 years of intermittent nasal discharge of cerebrospinal fluid (CSF). One month before admission, the patient had received treatment with cefadroxil. This case illustrates the risk of Gram-negative bacillary meningitis in patients with a CSF leak when they are treated with antibiotics. When patients have a chronic clear nasal discharge, one should look for a past medical history of head injury before prescribing antibiotics. In the presence of a fistula, any antibiotherapy may lead to the selection of resistant organisms which may be difficult to treat. Due to the high risk of meningitis and the fact that spontaneous closure in delayed CSF rhinorrhoea is unlikely, surgical repair of any associated fistulae is mandatory.
Insights
Serratia marcescens meningitis is rare in adults, especially after head injury. Antibiotic treatment for cerebrospinal fluid (CSF) leaks can lead to difficult-to-treat Gram-negative meningitis.
Area of Science:
- Neuroscience
- Infectious Diseases
Background:
- Serratia marcescens is an uncommon cause of community-acquired meningitis in adults.
- Cerebrospinal fluid (CSF) leaks, particularly following head trauma, represent a potential pathway for infection.
Observation:
- A case of S. marcescens meningitis is presented, occurring 29 years post-head injury.
- The patient experienced 3 years of intermittent clear nasal discharge (CSF leak) prior to meningitis.
- The patient had received cefadroxil treatment one month before admission.
Findings:
- This case highlights the risk of Gram-negative bacillary meningitis in individuals with CSF leaks treated with antibiotics.
- Antibiotic therapy in the presence of a fistula can select for resistant organisms, complicating treatment.
Implications:
- Patients with chronic clear nasal discharge should be evaluated for a history of head injury before antibiotic prescription.
- Surgical repair of CSF fistulae is crucial due to the high risk of meningitis and the low likelihood of spontaneous closure.