Indian J Pediatr (February 2015) 82(2):199–200 DOI 10.1007/s12098-014-1528-y
SCIENTIFIC LETTER
Cerebral Abscess due to Serratia marcescens Saikat Patra & Ramesh Bhat Y & Leslie E. Lewis & Jayashree Purakayastha & V. Vamsi Sivaramaraju
Received: 19 June 2013 / Accepted: 26 June 2014 / Published online: 24 July 2014 # Dr. K C Chaudhuri Foundation 2014
To the Editor: A 4-mo-old boy, who had stormy neonatal course, presented to us with increasing head size. There was no history of irritability, excessive sleepiness or vomiting. Examination revealed bulging anterior fontanelle, sunset sign, proptosis on right side and head circumference (HC) of 39 cm (4 cm increase over 1 mo). Neurological examination and systemic examination were normal. He was born at 32 wk gestation, weighed 1.3 kg with HC of 28.5 cm and received surfactant. Sepsis work up on 10th day for frequent apnea, revealed elevated Band: Neutrophil ratio (0.63) and blood culture grew Serratia marcescens. Cerebrospinal fluid analysis was normal and culture was sterile. He was treated with piperacillin-tazobactam and amikacin for 14 d. Repeat blood culture was sterile. He required ventilator support and parenteral nutrition through peripherally inserted central catheter (PICC) for 2 wk. He was discharged on day 42 with HC of 31 cm. First and fourth week neurosonograms were normal. Neurosonogram, currently, revealed an encapsulated right frontal lobe abscess. Magnetic resonance imaging brain further confirmed the abscess (Fig. 1a). Abscess was drained and S. marcescens with similar antibiogram as that of previous blood culture grew in pus. Piperacillin-tazobactam and amikacin were given and Computed tomography (CT) brain 2 wk later showed recollection of abscess requiring drainage twice again. Intravenous antibiotics were given for 6 wk, and he was discharged with HC and weight of 40 cm and 4,545 g respectively. He was conscious, recognizing mother and had normal tone and deep tendon reflexes. The proptosis had subsided. He was given oral cotrimoxazole and ciprofloxacin S. Patra (*) : R. Bhat Y : L. E. Lewis : J. Purakayastha : V. V. Sivaramaraju Department of Pediatrics, Kasturba Medical College, Manipal University, Manipal 576104, Karnataka, India e-mail: [email protected]
Fig. 1 a Magnetic resonance imaging (MRI) brain showing a large, well defined fluid signal intensity lesion with thick regular peripheral enhancement, air-fluid levels and internal septations in the right frontal lobe with mass effect suggestive of cerebral abscess b Follow up computed tomography (CT) scan brain showing resolution of the right frontal lobe abscess with gliotic changes in bilateral frontal regions and subdural hygroma
200
for 2 more weeks and then CT brain revealed resolution of abscess (Fig. 1b). Increasing S. marcescens sepsis in neonatal ICUs [1–5] with predisposing factors such as prematurity, very-low-birthweight [1, 3], patent ductus arteriosus [1], PICC and invasive procedures [3] have been recognized recently. S. marcescens usually causes pulmonary and central nervous system (CNS) infections [2], however cerebral abscess is an extremely rare complication [1]. Our case had risk factors and unusual cerebral abscess. Commonly used antibiotics like ampicillin, gentamicin or cefotaxime do not prevent CNS spread of S. marcescens [1] as observed in this case. Prompt recognition and therapy of cerebral abscess is paramount in preventing further catastrophy. Conflict of Interest None. Source of Funding None.
Indian J Pediatr (February 2015) 82(2):199–200
References 1. Hirooka TM, Fontes RB, Diniz EM, Pinto FC, Matushita H. Cerebral abscess caused by Serratia marcescens in a premature neonate. Arq Neuropsiquiatr. 2007;65:1018–21. 2. Polilli E, Parruti G, Fazii P, D’Antonio D, Palmieri D, D’Incecco C, et al. Rapidly controlled outbreak of Serratia marcescens infection/ colonisations in a neonatal intensive care unit, Pescara General Hospital, Pescara, Italy, April 2011. Euro Surveill. 2011; 16. pii: 19892. 3. Arslan U, Erayman I, Kirdar S, Yuksekkaya S, Cimen O, Tuncer I, et al. Serratia marcescens sepsis outbreak in a neonatal intensive care unit. Pediatr Int. 2010;52:208–12. 4. Guler E, Davutoglu M, Ucmak H, Karabiber H, Kokoglu OF. An outbreak of Serratia marcescens septicemia in neonates. Indian Pediatr. 2009;46:61–3. 5. Maragakis LL, Winkler A, Tucker MG, Cosgrove SE, Ross T, Lawson E, et al. Outbreak of multidrug-resistant Serratia marcescens infection in a neonatal intensive care unit. Infect Control Hosp Epidemiol. 2008;29:418–23.
SCIENTIFIC LETTER
Cerebral Abscess due to Serratia marcescens Saikat Patra & Ramesh Bhat Y & Leslie E. Lewis & Jayashree Purakayastha & V. Vamsi Sivaramaraju
Received: 19 June 2013 / Accepted: 26 June 2014 / Published online: 24 July 2014 # Dr. K C Chaudhuri Foundation 2014
To the Editor: A 4-mo-old boy, who had stormy neonatal course, presented to us with increasing head size. There was no history of irritability, excessive sleepiness or vomiting. Examination revealed bulging anterior fontanelle, sunset sign, proptosis on right side and head circumference (HC) of 39 cm (4 cm increase over 1 mo). Neurological examination and systemic examination were normal. He was born at 32 wk gestation, weighed 1.3 kg with HC of 28.5 cm and received surfactant. Sepsis work up on 10th day for frequent apnea, revealed elevated Band: Neutrophil ratio (0.63) and blood culture grew Serratia marcescens. Cerebrospinal fluid analysis was normal and culture was sterile. He was treated with piperacillin-tazobactam and amikacin for 14 d. Repeat blood culture was sterile. He required ventilator support and parenteral nutrition through peripherally inserted central catheter (PICC) for 2 wk. He was discharged on day 42 with HC of 31 cm. First and fourth week neurosonograms were normal. Neurosonogram, currently, revealed an encapsulated right frontal lobe abscess. Magnetic resonance imaging brain further confirmed the abscess (Fig. 1a). Abscess was drained and S. marcescens with similar antibiogram as that of previous blood culture grew in pus. Piperacillin-tazobactam and amikacin were given and Computed tomography (CT) brain 2 wk later showed recollection of abscess requiring drainage twice again. Intravenous antibiotics were given for 6 wk, and he was discharged with HC and weight of 40 cm and 4,545 g respectively. He was conscious, recognizing mother and had normal tone and deep tendon reflexes. The proptosis had subsided. He was given oral cotrimoxazole and ciprofloxacin S. Patra (*) : R. Bhat Y : L. E. Lewis : J. Purakayastha : V. V. Sivaramaraju Department of Pediatrics, Kasturba Medical College, Manipal University, Manipal 576104, Karnataka, India e-mail: [email protected]
Fig. 1 a Magnetic resonance imaging (MRI) brain showing a large, well defined fluid signal intensity lesion with thick regular peripheral enhancement, air-fluid levels and internal septations in the right frontal lobe with mass effect suggestive of cerebral abscess b Follow up computed tomography (CT) scan brain showing resolution of the right frontal lobe abscess with gliotic changes in bilateral frontal regions and subdural hygroma
200
for 2 more weeks and then CT brain revealed resolution of abscess (Fig. 1b). Increasing S. marcescens sepsis in neonatal ICUs [1–5] with predisposing factors such as prematurity, very-low-birthweight [1, 3], patent ductus arteriosus [1], PICC and invasive procedures [3] have been recognized recently. S. marcescens usually causes pulmonary and central nervous system (CNS) infections [2], however cerebral abscess is an extremely rare complication [1]. Our case had risk factors and unusual cerebral abscess. Commonly used antibiotics like ampicillin, gentamicin or cefotaxime do not prevent CNS spread of S. marcescens [1] as observed in this case. Prompt recognition and therapy of cerebral abscess is paramount in preventing further catastrophy. Conflict of Interest None. Source of Funding None.
Indian J Pediatr (February 2015) 82(2):199–200
References 1. Hirooka TM, Fontes RB, Diniz EM, Pinto FC, Matushita H. Cerebral abscess caused by Serratia marcescens in a premature neonate. Arq Neuropsiquiatr. 2007;65:1018–21. 2. Polilli E, Parruti G, Fazii P, D’Antonio D, Palmieri D, D’Incecco C, et al. Rapidly controlled outbreak of Serratia marcescens infection/ colonisations in a neonatal intensive care unit, Pescara General Hospital, Pescara, Italy, April 2011. Euro Surveill. 2011; 16. pii: 19892. 3. Arslan U, Erayman I, Kirdar S, Yuksekkaya S, Cimen O, Tuncer I, et al. Serratia marcescens sepsis outbreak in a neonatal intensive care unit. Pediatr Int. 2010;52:208–12. 4. Guler E, Davutoglu M, Ucmak H, Karabiber H, Kokoglu OF. An outbreak of Serratia marcescens septicemia in neonates. Indian Pediatr. 2009;46:61–3. 5. Maragakis LL, Winkler A, Tucker MG, Cosgrove SE, Ross T, Lawson E, et al. Outbreak of multidrug-resistant Serratia marcescens infection in a neonatal intensive care unit. Infect Control Hosp Epidemiol. 2008;29:418–23.
