|Year : 2018 | Volume
| Issue : 3 | Page : 213-215
Elizabethkingia meningoseptica: An emerging pathogen causing neonatal meningitis
Siva Kalyani Chamalla1, Satya Sri Karri2, Sesagiri Koripadu3, Nitin Mohan4
1 Consultant Microbiologist, Department of Microbiology, Vijaya Diagnostic Centre, Visakhapatnam, Andhra Pradesh, India
2 Consultant Pathologist, Department of Pathology, Omni RK Hospital, Visakhapatnam, Andhra Pradesh, India
3 Consultant Neonatologist, Department of Paediatrics, Omni RK Hospital, Visakhapatnam, Andhra Pradesh, India
4 Senior Resident, Department of Microbiology, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India
|Date of Web Publication||17-Sep-2018|
Dr. Nitin Mohan
Gandhinagar First Line, Berhampur - 760 001, Odisha
Source of Support: None, Conflict of Interest: None
Cerebrospinal fluid from a near-term second twin female baby with a history of seizures and respiratory distress requiring ventilator support was sent to our laboratory for culture. Light yellow colored colonies of 1-2 mm diameter of Gram-negative bacilli on chocolate and blood agar with no growth on MacConkey agar seen. The bacterium was multidrug resistant. Based upon the growth characteristics, bio-chemical reactions, drug susceptibility pattern and identification by Vitek 2 system (BioMerieux, France) the isolate was identified as Elizabethkingia meningoseptica. Treatment was started with cefoperazone-sulbactam. Baby subsequently developed hydrocephalus and required the insertion of a ventriculo-peritoneal shunt. Baby slowly improved and was discharged. The presence in the hospital environment along with multidrug resistance makes E. meningoseptica a successful emerging nosocomial pathogen.
Keywords: Elizabethkingia meningoseptica, meningitis, multidrug resistant, nosocomial spread
|How to cite this article:|
Chamalla SK, Karri SS, Koripadu S, Mohan N. Elizabethkingia meningoseptica: An emerging pathogen causing neonatal meningitis. J NTR Univ Health Sci 2018;7:213-5
|How to cite this URL:|
Chamalla SK, Karri SS, Koripadu S, Mohan N. Elizabethkingia meningoseptica: An emerging pathogen causing neonatal meningitis. J NTR Univ Health Sci [serial online] 2018 [cited 2018 Dec 18];7:213-5. Available from: http://www.jdrntruhs.org/text.asp?2018/7/3/213/241278
| Introduction|| |
Elizabethkingia meningoseptica is an uncommon pathogen infrequently isolated from clinical specimens. Formerly known as Centers for Disease Control group IIa, Flavobacterium meningosepticum and Chryseobacterium meningosepticum, is Gram-negative, rod-shaped bacterium widely distributed in nature. It was first recognized as a cause of neonatal meningitis by Elizabeth King in 1959. The first case of infection by this organism in India was reported way back in 1988-1989 as a pathogen causing neonatal meningitis. Studies from Hyderabad have reported this rare pathogen causing infections in neonates and adults admitted for medical causes., This is probably the first case report of neonatal meningitis caused by E. meningoseptica in our region.
| Case Report|| |
A specimen of cerebrospinal fluid (CSF) was received in our laboratory from a super specialty hospital for women and children. The specimen was from a near-term second twin female baby of 1.8 kg birth weight delivered by cesarean section in another hospital and was referred to present hospital because she developed respiratory distress, poor feeding and failure to thrive and was sent here for further care on day 12. There was a history of seizures on day 2. Lumbar puncture was performed, and the baby was put on ventilator support. The infant was started on intravenous phenobarbitone, meropenem and tigecycline along with supportive measure. The CSF findings were consistent with bacterial meningitis.
Cerebrospinal fluid culture on nutrient agar showed smooth, circular, 1-2 mm, slightly yellow pigmented colonies with entire edges and regular margins after 24 h [Figure 1]. On blood agar, 1-2 mm smooth, circular, greyish-white nonhemolytic colonies were seen. Growth was absent on MacConkey agar. The nonmotile Gram-negative bacillus was catalase positive, oxidase positive, nonfermenting, mannitol negative, indole weak positive, Triple sugar iron agar K/K/H2S, urease negative, nitrate reductase negative, unable to utilize citrate as the sole source of carbon and hydrolyzed esculin and gelatin. The isolate was identified as E. meningoseptica. The identification was also confirmed by Vitek 2 system (BioMerieux, France). A repeat CSF culture was performed, and the same isolate was obtained. Antimicrobial susceptibility testing was done by both the Clinical and Laboratory Standards Institute (CLSI) disc diffusion method and Vitek 2 automated system (BioMerieux, France). As CLSI has not established breakpoints for this rare pathogen, the interpretive breakpoints for Gram-negative and Gram-positive bacteria were used. The isolate was sensitive to cefoperazone-sulbactam, nalidixic acid and ciprofloxacin, and resistant to ampicillin, amoxicillin-clavulanic acid, cefuroxime, cefuroxime axetil, ceftriaxone, cefepime, imipenem, meropenem, amikacin, gentamycin, nitrofurantoin and colistin. It had intermediate susceptibility to tigecycline.
|Figure 1: Nutrient agar plate showing slightly yellow pigmented colonies of Elizabethkingia meningoseptica|
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Treatment was started with cefoperazone-sulbactam. Baby was weaned off the ventilator in 7 days. However, the baby subsequently developed hydrocephalus and required the insertion of a ventriculo-peritoneal shunt. Baby slowly improved and was discharged with ventriculo-peritoneal shunt in situ.
| Discussion|| |
In newborns, meningitis is the most common disease caused by E. meningoseptica. Prematurity is a primary risk factor for infection, and half of the infections have involved neonates weighing <2500 g. As an agent of neonatal meningitis, it reportedly demonstrates mortality rates up to 57% and produces severe postinfectious sequelae including brain abscesses, hydrocephalus, deafness, and developmental delay. In the present case the patient was a near-term infant and had developed hydrocephalus.
Antimicrobial susceptibility data of E. meningoseptica is scarce as it is a rare pathogen. Moreover, results of susceptibility testing vary when different methods (viz., disc diffusion, microbroth dilution and E test) are used. Even CLSI has no recommendations for performance and interpretation of antimicrobial susceptibility tests for this rare pathogen.
Elizabethkingia meningoseptica has a unique antibiogram and this pathogen though being a Gram-negative bacillus is inherently resistant to many antimicrobial agents commonly used to treat infections caused by Gram-negative bacteria (aminoglycosides, beta-lactam antibiotics, tetracyclines and chloramphenicol) but are often susceptible to agents generally used to treat infections caused by Gram-positive bacteria (rifampicin, clindamycin, erythromycin, trimethoprim-sulfamethoxazole, quinolones and vancomycin). This often leads to inappropriate choice of antibiotics for initial empirical therapy and results in treatment failures.,, The present isolate was susceptible to cefoperazone-sulbactam as was from a study by Sudharani et al. from Hyderabad.
It is resistant to multiple antibiotics, especially beta-lactams as it produces two beta-lactamases viz., extended-spectrum beta-lactamase and a carbapenem hydrolyzing metallo beta-lactamase conferring resistance to many extended spectrum beta-lactam antibiotics, aztreonam and carbapenems.
Environmental studies have revealed that these organisms can survive in chlorine-treated municipal water supplies, often colonizing sink basins and taps and creating potential reservoirs for infections inside hospital environments. Colonization of patients via contaminated medical devices involving fluids (respirators, intubation tubes, mist tents, humidifiers, incubators for newborns, ice chests, syringes, etc.,) has been documented. Environmental surveillance was not performed to identify the source of this pathogen. No other patients in the ward developed infections with the same bacteria. It is quite possible that the baby might have acquired the infection during his previous stay at the hospital in which he was delivered.
Elizabethkingia meningoseptica is likely to be encountered more frequently in the future because of its resistance to multiple antibiotics. It is, therefore, essential that laboratories have the ability to identify the organism correctly. Good communication between clinicians and laboratory staff is also important for the management of infected patients. Finally, neonatal meningitis caused by E. meningoseptica should be diagnosed and promptly treated with appropriate antibiotics to reduce the risk of mortality and of neurological sequelae.
| Conclusion|| |
This case shows that E. meningoseptica should be added to the list of agents that cause severe infections in newborn babies.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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