Cefalohematoma neonatal infectat per Escherichia coli I meningitis asèptica / Cefalohematoma neonatal infectado por escherichia coli y meningitis aséptica / Escherichia coli-infected neonatal cephalohematoma and aseptic meningitis

INTRODUCCIÓ: Un cefalohematoma és una col·lecció de sang sota el periosti del crani secundària a un traumatisme del part. Afecta entre l'1% I el 2% dels nadons nascuts per un part vaginal I entre el 3% I el 4% dels nascuts mitjançant un part instrumentat. Solen ser benignes I autolimitats, I es resolen espontàniament al cap d'unes setmanes, però alguns casos poden anar acompanyats d'anèmia, hiperbilirubinèmia o fractura cranial, complicar-se amb una calcificació o, rarament, infectar-se. CAS CLINIC: Nounat a terme de 9 dies de vida amb un cefalohematoma present des del naixement que va augmentar de mida després de tenir febre I infectar-se per Escherichia coli, suposadament per l'extensió d'una bacterièmia, I que es va acompanyar d'una meningitis asèptica (pleocitosi) que es va considerar secundària a una osteomielitis per contigüitat. El pacient es va tractar amb antibiòtics I desbridament quirúrgic, I no va tenir seqüeles. COMENTARIS: Cal tenir present que els cefalohematomes, tot I que habitualment tenen un curs autolimitat I una bona evolució, són un lloc potencial d'infecció, I que cal sospitar I descartar la infecció en un pacient amb febre I l'existència prèvia d'un cefalohematoma. S'han descrit casos de meningitis associats a cefalohematoma, però, fins on sabem, només un de meningitis asèptica com el descrit I que es va considerar, a diferència del que presentem, secundària a un retard en la recollida del líquid cefaloraquidi després d'iniciada l'antibioteràpia

INTRODUCCIÓN: Un cefalohematoma es una colección de sangre debajo del periostio del cráneo secundaria a un traumatismo del parto. Afecta a entre el 1% y el 2% de los neonatos nacidos mediante un parto vaginal y a entre el 3% y el 4% de los nacidos mediante un parto instrumentado. Suelen ser benignos, autolimitados y resolverse espontáneamente en semanas, pero en algunos casos se pueden acompañar de anemia, hiperbilirrubinemia o fractura craneal, complicarse con una calcificación o, raramente, infectarse. CASO CLÍNICO: Recién nacido a término de 9 días de vida con un cefalohematoma presente desde el nacimiento que aumentó de tamaño tres haber tenido fiebre e infectarse por Escherichia coli, supuestamente por la extensión de una bacteriemia, y que se acompañó de una meningitis aséptica (pleocitosis) que se consideró secundaria a una osteomielitis por contigüidad. El paciente se trató con antibióticos y desbridamiento quirúrgico y no tuvo secuelas. COMENTARIOS: Debemos tener en cuenta que los cefalohematomas, a pesar de que habitualmente tienen un curso autolimitado y una buena evolución, son un lugar potencial de infección, y que hay que sospechar y descartar la infección en un paciente con fiebre y la existencia de un cefalohematoma previo. Se han descrito algunos casos de meningitis asociados a cefalohematoma, pero hasta donde sabemos solo uno de meningitis aséptica como el descrito y que se consideró, a diferencia del que presentamos, secundaria a un retraso en la recogida del líquido cefalorraquídeo tras el inicio de la antibioterapia

INTRODUCTION: A cephalohematoma is a collection of blood below the periosteum of the skull due to birth trauma. It affects 1-2% of spontaneous vaginal deliveries and 3-4% of instrument-assisted deliveries. It is usually a self-limiting, benign condition which resorbs within weeks. A small proportion of cases can be accompanied by anemia, hyperbilirubinemia or a skull fracture, or be complicated by calcification or rarely by infection. CASE REPORT: 9-day-old full term neonate with a cephalohematoma present at birth that enlarged after the cephalohematoma got infected by Escherichia coli during a septic episode. Aseptic meningitis (pleocytosis) was assumed to be due to contiguous osteomyelitis. The patient was successfully treated with antibiotics and surgical debridement and showed no sequelae. COMMENTS: Clinicians should be aware that even though cephalohematomas are usually a benign, self-limiting condition, they are a potential site of infection. Infection must be suspected and ruled out in a patient with fever and a pre-existing cephalohematoma. A few cases of meningitis accompanying an infected cephalohematoma have been reported, although, to our knowledge, there is only one report of an associated aseptic meningitis. In contrast to the patient we present, in the other reported case lumbar puncture was performed 24 hours after onset of antibiotic treatment, which was suggested as the reason for the cerebrospinal fluid to be sterile

Colonic perforation by an intrathecal baclofen pump catheter causing delayed Escherichia coli meningitis.

Intrathecal baclofen (ITB) delivery via an implanted pump is frequently used for the treatment of spasticity. This is an effective and safe neurosurgical and pharmacological intervention associated with an improvement in patient quality of life. There is, however, a risk of device-related infection. We present a patient with pump-site infection and Escherichia coli meningitis secondary to transcolonic perforation of an intrathecal baclofen pump catheter. While this is rare, we review the intraoperative precautions and best practices that should be taken to prevent and manage this unusual complication.

Fcγ receptor I alpha chain (CD64) expression in macrophages is critical for the onset of meningitis by Escherichia coli K1.

Neonatal meningitis due to Escherichia coli K1 is a serious illness with unchanged morbidity and mortality rates for the last few decades. The lack of a comprehensive understanding of the mechanisms involved in the development of meningitis contributes to this poor outcome. Here, we demonstrate that depletion of macrophages in newborn mice renders the animals resistant to E. coli K1 induced meningitis. The entry of E. coli K1 into macrophages requires the interaction of outer membrane protein A (OmpA) of E. coli K1 with the alpha chain of Fcγ receptor I (FcγRIa, CD64) for which IgG opsonization is not necessary. Overexpression of full-length but not C-terminal truncated FcγRIa in COS-1 cells permits E. coli K1 to enter the cells. Moreover, OmpA binding to FcγRIa prevents the recruitment of the γ-chain and induces a different pattern of tyrosine phosphorylation of macrophage proteins compared to IgG2a induced phosphorylation. Of note, FcγRIa(-/-) mice are resistant to E. coli infection due to accelerated clearance of bacteria from circulation, which in turn was the result of increased expression of CR3 on macrophages. Reintroduction of human FcγRIa in mouse FcγRIa(-/-) macrophages in vitro increased bacterial survival by suppressing the expression of CR3. Adoptive transfer of wild type macrophages into FcγRIa(-/-) mice restored susceptibility to E. coli infection. Together, these results show that the interaction of FcγRI alpha chain with OmpA plays a key role in the development of neonatal meningitis by E. coli K1.

Suppurative meningitis in a 7-day-old Formosan sambar deer (Cervus unicolor swinhoei) caused by Escherichia coli.

This article describes the clinical and pathological features of an orphan 7-day-old, male Formosan sambar fawn that was hospitalized for treatment of weakness. The fawn had been deprived of colostrum and developed suppurative meningitis that was attributed to Escherichia coli.

[Escherichia coli meningitis and parietal osteomyelitis in an infant: a rare complication of cephalohematoma]. / Méningite à Escherichia coli associée à une ostéomyélite de l'os pariétal chez un nourrisson: une complication rare d'un céphalhématome.

We report the case of a 30-day-old infant presenting a E. coli meningitis with recurrence 5 days after stopping antibiotics. The clinical investigations concluded to the diagnosis of osteomyelitis of the parietal bone probably as a consequence of the infection of a cephalohematoma due to a wound caused by a foetal monitoring. Cephalohematoma is frequent in infant and is usually without consequences. Though rare, cases of infected cephalohematomas are described in the literature, with possible complications of meningitis (E. coli) and osteomyelitis. Sometimes the both pathologies are associated. A secondary infection of cephalohematomas must be taken in consideration when the etiology of a E. coli meningitis is not quite clear enough. In this situation, looking for an osteomyelitis whose presence may influence the infant's treatment is needed.

[A serious and unexpected infectious complication after transrectal prostate biopsy]. / Une complication infectieuse grave inattendue après biopsie transrectale de prostate.

Serious infectious complications may appear after a surgical procedure despite antimicrobial prophylaxis. We report a case of Escherichia Coli meningitis after a prostate puncture biopsy. Many factors may have contributed to this rare complication such as fluoroquinolone resistance, and/or the bacterium's ability to cross the brain blood barrier. The patient was not found susceptible to severe infections.

Acute bacterial meningitis after transrectal needle biopsy of the prostate: a case report.

Transrectal biopsy of the prostate (TBP) is the most accurate method of diagnosing prostate cancer. Although debate remains, prophylactic antibiotic therapy is most frequently used to prevent infectious complications after TBP. Here, we present a case of Escherichia coli meningitis after TBP despite quinolone prophylaxis.

Giant anterior sacral meningocele presenting as bacterial meningitis in a previously healthy adult.

Meningocele may be asymptomatic and incidentally discovered. Presenting as a retrorectal mass, sacral meningocele may produce urinary, rectal, and menstrual pain. Anterior sacral meningocele may be the cause of tethered cord syndrome. This article presents a case of a previously healthy 39-year-old man with large meningeal herniation that occupied the entire pelvis who developed symptoms of bacterial meningitis. A 39-year-old man was admitted with fever, chills, headache and photophobia. Escherichia coli was isolated from cerebrospinal fluid culture. Moderate improvement regarding meningeal symptoms was noted due to intravenous antibiotic therapy, but intense pain in the lower back associated with constipation, fecal and urinary incontinence, and saddle anesthesia developed. Abdominal ultrasound was negative. Plain radiographs and computed tomography demonstrated sacral bone defect and retrorectal expansive mass. MRI confirmed anterior sacral meningocele with cord tethering. After posterior laminectomy and dural opening, communication between meningocele and intrathecal compartment was obliterated. Computed tomography-guided percutaneous drainage through the ischiorectal fossa was performed to treat residual presacral cyst. Delayed diagnosis in our patient was related to misleading signs of bacterial meningitis without symptoms of intrapelvic expansion until the second week of illness. In our patient, surgical treatment was unavoidable due to resistive meningitis, acute back pain, and symptoms of space-occupying pelvic lesion. Neurosurgical approach was successful in treatment of meningitis and neurological disorders. Computed tomography-guided evacuation of the residual retrorectal cyst was less invasive than laparotomy, resulting in normalization of defecation and miction despite incomplete evacuation. Further follow-up studies may provide insight into the most effective treatment of such conditions.

Currarino syndrome as an etiology of a neonatal Escherichia coli meningitis.

We report the case of a 29-day-old baby girl in whom Escherichia coli meningitis led to the diagnosis of Currarino syndrome (CS) (OMIM 176450), an autosomal-dominant genetic disorder associated with sacral agenesis, anorectal malformation, presacral masses and spinal cord malformations. Her condition improved with antibiotics and early surgical treatment. A familial study identified other genetically related individuals with similar symptoms.

[Multiresistant Escherichia coli meningitis after transrectal prostate biopsy]. / Méningite à Escherichia coli multirésistant après biopsie de prostate transrectale.

Transrectal prostate biopsy represents the most accurate technique to diagnose prostate cancer. More vigilance is necessary when fluoroquinolones are given as prophylactic agents because of the increase in Escherichia coli resistant strains. We report a case of multiresistant E. coli meningitis after transrectal biopsy resulting in the death of the patient.

[Acute meningitis after transrectal prostate biopsy]. / Akute Meningitis nach transrektaler Prostatapunktion.

Acute meningitis caused by Escherichia coli is a rare disease in adulthood. Medical procedures, e.g. surgical interventions, have been described as a cause. Infection by blood transmission of fecal E. coli is also known. We report a case of acute meningitis after transrectal prostate biopsy. E. coli could be identified both in the cerebrospinal fluid and in the blood culture. A broad initial antibiotic therapy was administered. After cultural isolation of E. coli the therapy was switched to cefotaxime. The initially comatose patient recovered swiftly.

Entry and intracellular replication of Escherichia coli K1 in macrophages require expression of outer membrane protein A.

Interactions between Escherichia coli K1, which causes meningitis in neonates, and macrophages have not been explored well. In this study we found that E. coli K1 was able to enter, survive, and replicate intracellularly in both murine and human macrophage cell lines, as well as in monocytes and macrophages of newborn rats. In addition, we demonstrated that OmpA (+) E. coli also enters and replicates in human peripheral blood monocytes in vitro. Outer membrane protein A (OmpA) expression on E. coli contributes to binding to macrophages, phagocytosis, and survival within macrophages. Opsonization with either complement proteins or antibody is not required for uptake and survival of the bacteria within the macrophages. Transmission electron microscopy and immunocytochemistry studies with the infected macrophages indicated that OmpA(+) E. coli multiplies enormously in a single phagosome and bursts the cell. Internalization of OmpA(+) E. coli by RAW 264.7 cells occurred by both actin- and microtubule-dependent processes, which are independent of RGD-mediated integrin receptors. Internalization and intracellular survival within phagocytic cells thus may play an important role in the development of bacteremia, which is crucial for E. coli crossing of the blood-brain barrier.

[Cerebral arteritis and cerebritis caused by subdural empyema: two cases report].

We report two cases of cerebral angitis and cerebritis caused by subdural empyema. A 22-year-old man, who complained of a headache and high fever, suddenly developed unconsciousness and right hemiparesis. CT and MRI demonstrated left subdural empyema with diffuse brain swelling. CT angiography showed diffuse narrowing of the left internal carotid artery, middle cerebral artery, and anterior cerebral artery. Although we performed craniotomy, continuous irrigation with drainage, systemic injection of antibiotics for subdural empyema, antiplatelet therapy, and hyperbaric oxygen therapy for angitis, his condition remained unchanged. A 67-year-old man who had previously undergone burr hole surgery presented to our hospital for the treatment of scalp infection. He suddenly developed unconsciousness and right hemiparesis. CT and MRI demonstrated left subdural empyema with diffuse brain swelling, but MR angiography did not show any abnormal findings. Hemiparesis improved after the surgery and systemic injection of the antibiotics. Subdural empyema with sinusitis or meningitis around the skull base sometimes causes cerebral angitis. We considered that the angiographical evaluation for the subdural empyema was necessary to detect angitis.

Further characterization of Escherichia coli brain microvascular endothelial cell invasion gene ibeA by deletion, complementation, and protein expression.

The ibeA gene (ibe10) previously identified by TnphoA mutagenesis is part of a 50-kDa full-length open-reading frame (ORF) encoded by a 1.37-kb DNA fragment. An isogenic in-frame deletion mutant of ibeA (ZD1) was constructed by chromosomal gene replacement with a suicide plasmid pCVD442 carrying a 2.1-kb DNA fragment with an ibeA deletion. Similar to the previously described TnphoA insertion mutant of ibeA, the isogenic ibeA deletion mutant ZD1 was significantly less invasive in human brain microvascular endothelial cells (BMECs) than the parent strain. The mutant ZD1 was fully complemented by the ibeA ORF. The ibeA gene was subcloned into pET28a(+) and was expressed as a recombinant protein with an N-terminal histidine tag. The recombinant IbeA protein had much greater activity (50 times) in blocking the invasion of BMECs by Escherichia coli K1 than did the partial protein fragment, which provides further evidence that ibeA is an important determinant for E. coli K1 invasion of BMECs.