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Kulkarni Acute pediatric bacterial meningitis due to the rare isolate, Pseudomonas putida

In a Spanish prospective observational study, 69.4% found increase in the cell count in more than 90%
and 30.5% cases of meningitis are community and of their culture positive specimen. On the contrary,
nosocomially acquired respectively. The etiologic Modi et al. reported the cell count of CSF sample to
[6]
[12]
agents of community acquired meningitis are vary from no cells to sheets of cells; they also reported
H.influenzae, N.meningitidis and S.pneumoniae high mean level of protein (90.2 ± 11.5 mg/dL) and a
whereas nosocomial meningitis is caused by Gram- mean sugar level of 32.2 ± 3.4 mg/dL.
negative bacilli (GNB) and Staphylococcus sp.
[6]
Another Spanish neonatal meningitis study revealed We did not perform CSF C-reactive protein, latex
55.6% and 44.37% of meningitis cases were agglutination test (LAT) and polymerase chain reaction
vertically and nosocomially transmitted respectively. (PCR). Chinchankar et al. reported CSF C-reactive
[4]
S.agalactiae was reported in 48.5% confirmed cases of protein and LAT positive in 41% and 78% of the cases
meningitis and in other cases E.coli and S.epidermidis respectively while culture was positive in only 50% of the
were isolated from 26.5% and 24.5% of the cases cases. Finlay et al. in their study, LAT confirmed the
[13]
respectively. [7] etiology of meningitis in 60% cases of S.pneumoniae,
93% of H.influenzae type B and 39% of N.meningitidis.
In an 8-year study from the Northern region of India, It also explains that though Gram stain and LAT
the majority of the patients (83.8%) were younger were positive in 50% of the cases after receiving the
than 12 years and majority of them were infants antibiotics, LAT is beneficial to identify the causative
(36.7%). Majority of the meningitis cases (69.2%) agent and to start the early treatment and vaccination
were community acquired and 30.8% were hospital of the patient, specially in case of meningococcal types
acquired. Overall, S.aureus predominated during the A and C. On the contrary, low sensitivity of LAT (13.5%)
8 years study period accounting for the total of 38% was reported by Tarafdar et al. in a brief report on
[14]
of all isolates followed by Pseudomonas sp (12%) and culture negative meningitis.
E.coli (11%). [8]
Broad range PCR for the early detection of bacterial
In the present study, Pseudomonas putida was meningitis showed 100% sensitivity, 98.2% specificity,
isolated from a 5-year-old girl. Bareja et al. in a study 94% positive predictive value and 100% negative
[9]
on the trends in bacteriology of meningitis reported, predictive value. Similarly, the other analytical study
[15]
P.aeruginosa to be responsible for 9.23% of pediatric displayed 54.5% sensitivity of the multiplex PCR in
meningitis cases, out of which majority of them comparison with Gram stain (29.2%) and culture
(29.4%) were seen in 1 to 3 years old children, less (34.5%). [16]
frequently were observed between 3 to 12 months of
age group children (17.64%) and in 3 to 5 years old Intially, in this case patient was treated with piperacillin
children (17.64%). Archibald et al. reported 2 cases and tazobactum, meropenem and vancomycin.
[10]
of Pseudomonas aeruginosa childhood meningitis. Pseudomonas putida displayed in vitro sensitivity to
Yang et al. isolated P.putida in CSF causing amikacin, ciprofloxacin, levofloxacin and minocycline
[11]
meningitis in 2 of their 55 patients (5%) with P.putida and moderate sensitivity to gentamicin and cefepime.
infections. It was totally resistant to piperacillin and tazobactum,
cefoperazone and sulbactum, cotrimoxazole, doripenem
In the present study, Gram stain did not show any and tigeycycline. Later on the antibiotics were
organism and pus cells. In addition to this, blood and upgraded and patient gradually recovered. Results of
urine culture were sterile. CSF culture grew GNB the in vitro susceptibility test suggested that imipenem
resembling Alcaligenes fecalis (identified with limited and ceftazidime were more effective than the other
number of conventional biochemical tests) and later antimicrobials against P.putida. Similarly, as per other
[11]
on identified as Pseudomonas putida with automated CSF antibiogram analysis all strains of Pseudomonas
VITEK 2 (BIOMERIEUX, USA) system. Modi et al. sp were sensitive to imipenem. [12]
[12]
®
in a study on 252 CSF samples in patients with acute
childhood bacterial meningitis; 162 (64.3%) were In conclusion, ABM is the medical emergency with
smear positive and 200 (79.4%) were and culture high mortality rates. Rapid diagnosis and treatment are
positive. Bareja et al. reported only 58% Gram stain critical. We report a rare case of P. putida meningitis
[9]
positive samples and 23.5% culture positive. Almost which was successfully treated. An infection with rare
similar results of positive Gram stain (67%) and organisms is possible and a high index of suspicion can
cultures (50%) were reported by Chinchankar et al. [4] lead to accurate diagnosis and treatment in these cases.

In the present study, CSF analysis showed normal cell Traditional lab methods such as Gram stain and culture
count, normal protein and elevated sugar. Bareja et al. are used for identification of organism. PCR is the rapid,
[9]
Neuroimmunology and Neuroinflammation ¦ Volume 3 ¦ September 26, 2016 217