Saini Arushi G, Rathore Vinay, Ahuja Chirag K, Chhabra Rajesh, Vaidya Pankaj C, Singhi Pratibha
Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
J Infect Public Health. 2017 Sep-Oct;10(5):674-677. doi: 10.1016/j.jiph.2017.03.008. Epub 2017 May 22.
Brain abscesses due to Enterobacteriaceae in immune-competent children are rare, and those due to Enterobacter cloacae are even rarer. We report an interesting case of community-acquired E. cloacae neuroinfection resulting in multiple brain abscesses in a young child with no underlying risk-factors. A 10 year-old-boy presented with low-grade fever, headache, neck pain and progressive deterioration of sensorium. On examination, he was conscious but drowsy with photophobia, normal fundii, meningeal signs, mild hypertonia, brisk muscle stretch reflexes and extensor plantar responses. Magnetic resonance imaging of brain showed bilateral, multiple pyogenic abscesses. Culture of the abscess material aspirated at the time of surgical drainage showed growth of E. cloacae. He received intravenous imipenem for 18 weeks guided by clinical and radiological response. A pragmatic approach combining early surgical drainage, targeted antimicrobial therapy and patient-tailored duration based on the clinico-radiological response is needed in such difficult cases.
免疫功能正常儿童由肠杆菌科细菌引起的脑脓肿罕见，而由阴沟肠杆菌引起的则更为罕见。我们报告了一例有趣的社区获得性阴沟肠杆菌神经感染病例，该感染导致一名无基础危险因素的幼儿出现多发性脑脓肿。一名10岁男孩出现低热、头痛、颈部疼痛及意识进行性恶化。检查时，他意识清醒但嗜睡，有畏光现象，眼底正常，有脑膜刺激征，轻度肌张力增高，肌肉牵张反射活跃及跖伸反应。脑部磁共振成像显示双侧多发性化脓性脓肿。手术引流时抽取的脓肿材料培养显示有阴沟肠杆菌生长。根据临床和影像学反应，他接受了18周的静脉注射亚胺培南治疗。对于此类疑难病例，需要采取一种务实的方法，将早期手术引流、针对性抗菌治疗以及根据临床-影像学反应为患者量身定制治疗时长相结合。
