Case of meningitis in a neonate caused by an extended-spectrum-beta-lactamase-producing strain of hypervirulent Klebsiella pneumoniae

© 2017 Khaertynov, Anokhin, Davidyuk, Nicolaeva, Khalioullina, Semyenova, Alatyrev, Skvortsova and Abrahamyan. Klebsiella pneumoniae is one of the most important infectious agents among neonates. This pathogen has a potential to develop an increased antimicrobial resistance and virulence. The classic non-virulent strain of K. pneumoniae, producing an extended-spectrum beta-lactamases (ESBL), is associated with nosocomial infection mainly in preterm neonates. Hypervirulent K. pneumoniae strains are associated with invasive infection among previously healthy ambulatory patients, and most of them exhibit antimicrobial susceptibility. During the last few years, several cases of diseases caused by hypervirulent K. pneumoniae producing ESBL have been registered in different geographical regions of the world. However , reports of such cases in neonates are rare. Here, we reported that this pathogen can cause pyogenic meningitis in full-term neonate with poor prognosis. A previously healthy, full-term, 12-day-old neonate was admitted to the infectious diseases hospital with suspected meningitis. The clinical symptoms included loss of appetite, irritability, fever, seizures, and a bulging anterior fontanelle. The analysis of the cerebrospinal fluid confirmed the diagnosis of meningitis. Blood and cerebrospinal fluid cultures were positive for K. pneumoniae, producing ESBL. K. pneumoniae isolates were resistant to aminopenicillins, 3rd generation cephalosporins but were sensitive to imipenem and meropenem. The "string test" was positive. The study of the virulence factors of K. pneumoniae by PCR revealed the presence of the rmpA gene. A combination of K. pneumoniae virulence and drug resistance complicated by cerebral oedema led to the death of the neonate. We concluded that both the risk of developing severe forms of infection and the outcome of the disease due to K. pneumonia are associated with the phenotypic features of the pathogen such as its antibiotic susceptibility and virulence factors. Emergence of the ESBL-producing strain of hypervirulent K. pneumoniae could represent a new serious threat to public health, suggesting an urgent need to enhance clinical awareness and epidemiological surveillance

Meningitis in children of early age. Criteria for early diagnostics

Meningitis is characterized by the prevalence of severe forms and it is often accompanied by life-threatening syndromes.Purpose. To determine the most informative clinical manifestations of meningitis in children in their first years of life to optimize early diagnosis and treatment.Materials and methods. The authors carried out a retrospective analytical study involving 47 cases of children hospitalized to the Republican Clinical Hospital for Infectious Diseases in 2014–2016. Their diagnose was based on the acute onset of the disease, characteristic clinical symptoms and the results of lumbar puncture. The laboratory diagnostics included a standard set of examinations.Results. Meningitis was diagnosed in 34 patients (72.3%), meningoencephalitis – in 13 patients (27.7%). 30 cases (63.8%) of meningitis / meningoencephalitis had a bacterial nature, and 9 cases (19.1%; p<0.01) had a viral nature. The most common bacterial pathogens of meningitis was Pneumococcus (10 cases), hemophilus bacillus (8). Str. agalactiae (6) and meningococcus (6). 38 (80.9%) patients had high febrile fever, 1005 of patients had weakness, drowsiness, changes in consciousness of varying severity, 29 patients (61.7%) had vomiting, 16 patients ( 34%) – headache, “brain” cry, 7 patients (15%) – hyperesthesia, a symptom of “mother’s hands”, 4 patients (8.5%) – forced posture, 34 patients (72.3%) had meningeal signs.Conclusion. The most significant symptoms of early diagnosis of meningitis in children are high febrile fever combined with drowsiness and retardation, vomiting without diarrhea

Case of meningitis in a neonate caused by an extended-spectrum-beta-lactamase-producing strain of hypervirulent Klebsiella pneumoniae

© 2017 Khaertynov, Anokhin, Davidyuk, Nicolaeva, Khalioullina, Semyenova, Alatyrev, Skvortsova and Abrahamyan. Klebsiella pneumoniae is one of the most important infectious agents among neonates. This pathogen has a potential to develop an increased antimicrobial resistance and virulence. The classic non-virulent strain of K. pneumoniae, producing an extended-spectrum beta-lactamases (ESBL), is associated with nosocomial infection mainly in preterm neonates. Hypervirulent K. pneumoniae strains are associated with invasive infection among previously healthy ambulatory patients, and most of them exhibit antimicrobial susceptibility. During the last few years, several cases of diseases caused by hypervirulent K. pneumoniae producing ESBL have been registered in different geographical regions of the world. However , reports of such cases in neonates are rare. Here, we reported that this pathogen can cause pyogenic meningitis in full-term neonate with poor prognosis. A previously healthy, full-term, 12-day-old neonate was admitted to the infectious diseases hospital with suspected meningitis. The clinical symptoms included loss of appetite, irritability, fever, seizures, and a bulging anterior fontanelle. The analysis of the cerebrospinal fluid confirmed the diagnosis of meningitis. Blood and cerebrospinal fluid cultures were positive for K. pneumoniae, producing ESBL. K. pneumoniae isolates were resistant to aminopenicillins, 3rd generation cephalosporins but were sensitive to imipenem and meropenem. The "string test" was positive. The study of the virulence factors of K. pneumoniae by PCR revealed the presence of the rmpA gene. A combination of K. pneumoniae virulence and drug resistance complicated by cerebral oedema led to the death of the neonate. We concluded that both the risk of developing severe forms of infection and the outcome of the disease due to K. pneumonia are associated with the phenotypic features of the pathogen such as its antibiotic susceptibility and virulence factors. Emergence of the ESBL-producing strain of hypervirulent K. pneumoniae could represent a new serious threat to public health, suggesting an urgent need to enhance clinical awareness and epidemiological surveillance