Neonatal Citrobacter koseri meningitis and brain abscess

Abstract

Citrobacter koseri meningitis is a very rare cause of neonatal meningitis. It is characterized by serious complications like cerebral abscesses and high mortality. This is the first neonatal case of cerebral abscesses in UK following C. koseri meningitis, who survived with no serious neurological deficit. Serial neuroimaging is the key to diagnose cerebral complications early. Neonatal meningitis is a well known serious clinical condition associated with significant morbidity and mortality12 which can be complicated by brain abscess formation and ventriculitis.3456 Although there has been a decrease in the overall mortality in the last decade attributable to improved supportive care and the use of more efficacious antibiotics such as third generation cephalosprorins,7 the incidence and morbidity attributed to this condition has remained largely unchanged.12 Up to forty-five percent of neonatal meningitis is caused by Gram negative bacilli, 123 and is associated with high morbidity7 and mortality of about eighty percent.4 Neonatal meningitis caused by Citrobacter koseri is extremely rare and is often complicated by brain abscess and ventriculitis, with only a few cases reported from the USA,345 India,8 Brazil,9 Israel,10 and Canada.11 In the UK, there have been ten reported cases of Citrobacter meningitis, 12131415 nine of which were C. koseri and one C. freundii.