Spontaneous Proteus mirabilis Meningitis in Adults Requiring an Extended Antibiotic Course: Case Report and Literature Review.
| Autor: | Costa Filho FF; Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA., Furlan A; Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA., Avner BS; Internal Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, USA. |
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| Jazyk: | angličtina |
| Zdroj: | Cureus [Cureus] 2023 May 19; Vol. 15 (5), pp. e39225. Date of Electronic Publication: 2023 May 19 (Print Publication: 2023). |
| DOI: | 10.7759/cureus.39225 |
| Abstrakt: | Most cases of gram-negative bacillary meningitis occur in neonates and infants. Meningitis in adults caused by Proteus mirabilis has been reported rarely. Evidence-based guidelines for the treatment of adult patients with gram-negative bacillus meningitis are scarce. The optimal duration of antibiotic therapy for these patients is an unanswered question in the medical literature. This article outlines a case of community-acquired meningitis caused by P. mirabilis in an adult patient who required an extended antimicrobial treatment, after failing to a three-week antibiotic regime. Our patient, a 66-year-old man with a history of neurogenic bladder, remote spinal cord trauma, and recurrent urinary tract infections presented to the emergency department reporting a two-day history of severe headache, fever, and confusion. Cerebrospinal fluid (CSF) revealed significant neutrophil-predominant pleocytosis, low glucose level, and elevated protein level. CSF culture grew few pan-susceptible P. mirabilis . The patient initially completed 21 days of ceftriaxone guided by susceptibility testing. Nine days after finishing antibiotic therapy, the patient was readmitted with recurrent headache, fever, and neck rigidity. A new CSF study again revealed pleocytosis, elevated polymorphonuclear cells, low glucose level, and elevated protein level, but with a negative CSF culture. The patient became afebrile, and his symptoms improved after two days of ceftriaxone. He completed an additional six-week regime of ceftriaxone. On the one-month follow-up visit, the patient remained afebrile, with no recurrent symptoms. Spontaneous community-acquired P. mirabilis meningitis is rare among adult patients. Experiences in the treatment of gram-negative bacillus meningitis in adults must be shared with the scientific community to build up a better understanding of this condition. In the context of this case, sterilization of the CSF, extended antibiotic therapy, and a close post-treatment follow-up are crucial for treating this life-threatening condition. Competing Interests: The authors have declared that no competing interests exist. (Copyright © 2023, Costa Filho et al.) |
| Databáze: | MEDLINE |
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