Background: Elizabethkingia meningoseptica are Gram-negative rod bacteria which are commonly found in the environment. The bacteria have also been associated with nosocomial infections, having been isolated on contaminated medical equipment, especially in neonatal wards.
Case report: Here, we present the case of a premature female infant born at 33 weeks’ gestational age, with neonatal meningitis. The onset was marked by fever, in the 5th day of life, while in the Neonatal Intensive Care Unit. The patient was commenced on Gentamicin and Ampicillin, but her clinical condition worsened. Psychomotor agitation and food refusal developed in the 10th day of life, and a diagnosis of bacterial meningitis was made based on clinical and cerebrospinal fluid findings. A strain of Elizabethkingia meningoseptica sensitive to Vancomycin, Rifampicin and Clarithromycin was isolated from cerebrospinal fluid. First-line antibiotic therapy with Meropenem and Vancomycin was adjusted by replacing Meronem with Piperacillin/Tazobactam and Rifampicin. The patient’s clinical condition improved, although some isolated febrile episodes were still present. The cerebrospinal fluid was normalized after 6 weeks of antibiotic treatment, although periventriculitis and tetraventricular hydrocephalus were revealed by imaging studies. Neurosurgical drainage was necessary.
Conclusion: Elizabethkingia meningoseptica can cause severe infection, with high risk of mortality and neurological sequelae in neonates. Intensive care and multidisciplinary interventions are crucial for case management.
1. Bhat KS, Priya R, Krishnan L, Kanungo R. Elizabethkingia meningoseptica bacteremia in a neonate: A case report and mini-review of the literature. J Curr Res Sci Med. 2016;2:42-5.
2. Oren A, da Costa MS, Garrity GM, et al. Proposal to include the rank of phylum in the international code of nomenclature of prokaryotes. Int J Syst Evol Microbiol. 2015;65:4284–7.
3. Kim KK, Kim MK, Lim JH, Park HY, Lee ST. Transfer of Chryseobacterium meningosepticum and Chryseobacterium miricola to Elizabethkingia gen. nov. as Elizabethkingia meningoseptica comb. nov. and Elizabethkingia miricola comb. nov. Int J Syst Evol Microbiol. 2005;55(Pt 3):1287–93.
4. Breurec S, Criscuolo A, Diancourt L, et al. Genomic epidemiology and global diversity of the emerging bacterial pathogen Elizabethkingia anophelis. Sci Rep. 2016, 6:30379.
5. Chen S, Soehnlen M, Downes FP, Walker ED. Insights from the draft genome into the pathogenicity of a clinical isolate of Elizabethkingia meningoseptica Em3. Stand Genom Sci. 2017;12:56.
6. Jean SS, Lee WS, Chen FL, Ou TY, Hsueh PR. Elizabethkingia meningoseptica: an important emerging pathogen causing healthcare-associated infections. J Hosp Infect. 2014;86(4):244–9.
7. Pereira GH, Garcia DO, Abboud CS, Barbosa VLB, da PSL S. Nosocomial infections caused by Elizabethkingia meningoseptica: an emergent pathogen. Braz J Infect Dis. 2013;17:606–9.
9. Eriksen HB, Gumpert H, Faurholt CH, Westh H. Determination of Elizabethkingia Diversity by MALDI-TOF Mass Spectrometry and Whole-Genome Sequencing. Emerg Infect Dis. 2017;23(2):320-3.
10. Hsu MS, Liao CH, Huang YT, et al. Clinical features, antimicrobial susceptibilities, and outcomes of Elizabethkingia meningoseptica (Chryseobacterium meningosepticum) bacteremia at a medical center in Taiwan, 1999–2006. Eur J Clin Microbiol Infect Dis. 2011;30(10):1271–8.
11. Lin PY, Chen HL, Huang CT, Su LH, Chiu CH. Biofilm production, use of intravascular indwelling catheters and inappropriate antimicrobial therapy as predictors of fatality in Chryseobacterium meningosepticum bacteraemia. Int J Antimicrob Agents. 2010;36:436–40.
12. van de Beek D, Cabellos C, Dzupova O, et al. ESCMID guideline: Diagnosis and treatment of acute bacterial meningitis for the ESCMID Study Group for Infections of the Brain (ESGIB). Clin Microbiol Infect. 2016;22:S37-S62.
13. Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice Guidelines for Bacterial Meningitis. Clin Infect Dis. 2004;39:1267-84.
14. Brouwer MC, Tunkel AR, van de Beek D. Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. Clin Microbiol Rev. 2010;23(3):467–92.
15. Hsu MS, Liao CH, Huang YT, et al. Clinical features, antimicrobial susceptibilities, and outcomes of Elizabethkingia meningoseptica (Chryseobacterium meningosepticum) bacteremia at a medical center in Taiwan, 1999–2006. Eur J Clin Microbiol Infect Dis. 2011;30(10):1271–8.
16. Ceyhan M, Celik M. Elizabethkingia meningosepticum (Chryseobacterium meningosepticum) Infections in Children. Int J Pediatr. 2011:215-37.
17. Shah Z, Soodhana D, Kalathia M, Parikh Y. Elizabethkingia meningoseptica: an emerging threat. Int J Contemp Pediatr. 2017;4(5):1909-10.
18. Kavuncuoglu S, Gursoy S, Turel O, Aldemir EY, Hosaf E. Neonatal bacterial meningitis in Turkey: epidemiology, risk factors, and prognosis. J Infect Dev Ctries. 2013;7(2):73–81.
19. Lin PY, Chu C, Su LH, Huang CT, Chang WY, Chiu CH. Clinical and microbiological analysis of bloodstream infections caused by Chryseobacterium meningo-septicum in nonneonatal patients. J Clin Microbiol. 2004;42(7):3353–5.
20. Shinha T, Ahuja R. Bacteremia due to Elizabethkingia meningoseptica. IDcases. 2015;2(1):13-5.
21. Issack MI, Neetoo Y. An outbreak of Elizabethkingia meningoseptica neonatal meningitis in Mauritius. J Infect Dev Ctries. 2011;5(12):834–39.
22. Huang YC, Lin YT, Wang FD. Comparison of the therapeutic efficacy of fluoroquinolone and non-fluoroquinolone treatment in patients with Elizabethkingia meningoseptica bacteraemia. Int J Antimicrob Agents. 2018;51(1):47-51.
23. Vincent JL, Bassetti M, Francois B, et al. Advances in antibiotic therapy in the critically ill. Crit Care. 2016; 20:133.
24. Neuner EA, Ahrens CL, Groszek JJ, et al. Use of therapeutic drug monitoring to treat Elizabethkingia meningoseptica meningitis and bacteraemia in an adult. J Antimicrob Chemother. 2012;67:1558–60.
25. Newby BD, Timberlake KE, Lepp LM, Mihic T, Dersch-Mills DA. Levofloxacin Use in the Neonate: A Case Series. JPPT. 2017;22(4):304-13.
26. Bruun B, Tversrupjensen E, Lundstrom K, Andersen GE. The C meningosepticum infection in a Neonatal ward. Eur J Clin Microbiol Infect Dis. 1989;816:509-14.
27. Bloch KC, Nadarajah R, Jacobs R. Chryseobacterium meningosepticum: an emerging pathogen among immunocompromised adults. Report of 6 cases and literature review. Medicine (Baltimore), 1997;76: 30-41.