Citrobacter diversus ventriculitis and brain abscesses in an adult

A case of Citrobacter koseri renal abscess and review of the literature

Citrobacter species are anaerobic gram-negative bacteria that are known to cause infections in immunocompromised hosts, particularly in hospital settings. Their opportunistic nature and tendency to develop antibiotic resistance make Citrobacter species challenging to treat. Renal or perinephric abscess formation as a result of Citrobacter infection is uncommon, having only previously been reported in four cases. We present a case of a 70-year-old man with diabetes and prostate cancer who was diagnosed with an 18 cm perinephric and a 10 cm perihepatic abscess caused by Citrobacter koseri. The patient required drains and re-positioning of the drains multiple times in addition to a prolonged course of antibiotics to achieve complete radiographic resolution. This case highlights the challenges in treating renal and perinephric abscess, as it required drain re-placements two additional times after the initial placement and an additional 4 weeks of antibiotics. Successful treatment for larger abscesses usually requires a two-arm approach, with antibiotics in combination with either percutaneous or surgical abscess drainage.

Unusual cranial infection caused by Citrobacter Koseri

A 60-year-old female had a frontal bone intraosseous meningioma resected 10 years previously. On follow up CT head, an enlarging intraosseous frontal bone lesion was noted. This was thought to be a recurrent frontal meningioma. Intraooperatively, she was found to have an abscess deep to the cranioplasty.

Brain abscess caused by Citrobacter koseri infection in an adult

Citrobacter koseri is a gram-negative bacillus that causes mostly meningitis and brain abscesses in neonates and infants. However, brain abscess caused by Citrobacter koseri infection in an adult is extremely rare, and only 2 cases have been described. Here, we reported a 73-year-old male presenting with a 3-week headache. A history of diabetes mellitus was noted. The images revealed a brain abscess in the left frontal lobe and pus culture confirmed the growth of Citrobacter koseri. The clinical symptoms improved completely postoperatively.

Abscess caused by Citrobacter koseri infection: three case reports and a literature review

In this report, we present 3 cases of abscess caused by Citrobacter koseri. All infected patients recovered after initial empirical antibiotic treatment and percutaneous drainage of the abscess. We reviewed the literature and found 9 adult cases of C. koseri abscess. Most of these patients recovered after timely antibiotic treatment and drainage.

Fatal Citrobacter farmeri meningitis in a patient with nasopharyngeal cancer

We describe the case of an adult male with nasopharyngeal carcinoma who had meningitis caused by Citrobacter farmeri. The isolate was confirmed as C. farmeri by two commercial identification systems and 16S rRNA gene analysis. The patient developed multiorgan failure and died despite antibiotic treatment with in vitro active agents (ceftriaxone and meropenem).

Peritumoral Citrobacter koseri Abscess Associated with Parasagittal Meningioma

OBJECTIVE AND IMPORTANCE

This is the second report of a Citrobacter-associated brain abscess in an adult and the first report of its association with an intradural tumor. Excluding those associated with trauma, neurosurgical procedures, and proximity to the skull base, only seven other cases of abscesses associated with intracranial tumors have been published. Five of seven tumor-associated abscesses with a microbiological diagnosis involved gram-negative bacteria, a finding that may indicate a predilection of these microorganisms for intracranial tumors.

CLINICAL PRESENTATION

A 78-year-old female patient presented with a 6-month history of confusion and personality changes. Her medical history included paroxysmal atrial fibrillation and a 10-day course of high-dose dexamethasone but no other predisposing conditions for sepsis. She was afebrile, had no focal neurological deficits, and had no systemic abnormalities on examination. Computed tomographic imaging revealed a noncalcified, homogeneously enhancing, 3-cm-diameter, extra-axial tumor associated with the right anterior falx cerebri. The tumor did not extend to the skull base.

INTERVENTION

At craniotomy, 10 to 20 ml of thick pus was found around the posteroinferior surface of the tumor. On extended culture, this material demonstrated Citrobacter koseri growth, which was effectively treated with ceftriaxone followed by meropenem and one repeated abscess aspiration. No systemic source of the infection was found.

CONCLUSION

The characteristic endothelial invasiveness of Citrobacter and related gram-negative bacteria may predispose to the formation of abscesses in association with intracranial tumors.

Citrobacter koseri (diversus) meningitis in an otherwise healthy adolescent

Citrobacter infection is commonly reported in neonates and immunocompromised patients. Citrobacter koseri (diversus) is an important cause of neonatal meningitis and brain abscess formation. It adults, however, Citrobacter infection with central nervous system involvement is rare, and is usually associated with an underlying disorder. This report describes a 12-y-old previously healthy girl with Citrobacter koseri meningitis. Intravenous treatment with ceftriaxone for 10 d led to complete recovery. Head computed tomography and brainstem-evoked response audiometry were normal. On follow-up, the patient was completely healthy. Previously reported cases of C. koseri meningitis in the adult population were associated with underlying predisposing factors. In this case a normal, healthy adolescent was treated with intravenous ceftriaxone without any of the known neurological complications observed in the neonatal cases.

A flexible metal ventricular catheter for treatment of complicated and protracted infections of the cerebrospinal fluid spaces: preliminary experiences

In the management of shunt infection, the use of ventricular catheters made of silicone rubber for the temporary external drainage of cerebrospinal fluid (CSF) is general practice. However, the eradication of the primary source of infection may be hindered by the affinity of bacteria to silicone-based material. Compared to silicone catheters, a metal drainage device for temporary ventriculostomy appears to offer more favourable conditions for successful eradication of the infection. Since metal needles cannot be implanted permanently and since their screw-type fixation precludes attachment to the skulls of infants or small children, we developed a flexible metal catheter. This catheter was used exclusively for the treatment of particularly serious or chronic infections of the CSF spaces. The catheter is made of implantation steel and consists of a corrugated tube that renders it flexible. Cerebrospinal fluid drains into a receptable bulb at the tip of the tube. Tubing of other materials may be connected to the end of the metal catheter for either external or internal drainage. It was implanted as a temporary and later permanent CSF drainage in 7 male patients aged from 4 to 60 years, who suffered from chronic, recurrent ventriculitis (n = 5) with an average of 7 previous surgical revisions, as well as from complex infections (n = 2; basal tuberculous meningitis, brain abscess). The infections were successfully eliminated in 6 patients. In the remaining patient, the metal catheter for external ventriculostomy had to be removed after 4 days due a leakage of CSF; it was replaced by a silicone catheter and later on by a needle drainage. Other complications, such as secondary infection or intracerebral haemorrhage, did not occur. The average duration of external CSF drainage via the flexible metal catheter was 27 days (range 4-50 days). In 4 patients, the CSF drainage was converted to a permanent ventriculoperitoneal shunt using a new flexible metal catheter. At the time of post-operative follow-up examination (average = 34 weeks), all shunts were functioning and there was no evidence of infection. In cases of especially complicated and protracted CSF infections, the flexible metal ventricular catheter is a promising device for treatment.

Bifocal cervical spondylodiscitis due to Citrobacter diversus

Spondylodiscitis due to Citrobacter diversus is rare. An unusual case of bifocal cervical spondylodiscitis following transurethral prostatectomy is reported. C. diversus was detected by urinary cultures and locally by intervertebral disc puncture. Satisfactory recovery occurred after treatment with imipenem and amikacin, and then imipenem alone. Citrobacter infections are still rare in adults but are increasing in immunocompromised patients and sometimes occur in healthy subjects following surgery.