Plesiomonas shigelloides septicemia and meningitis in a neonate JULIAN DEASON MBBS MRCP (UK),DONLIM PEACOCK MBCHB FRCPC P lesiomonas shigelloides was originally isolated in 1947 by Ferguson and Henderson (1) who noted certain antigenic similarities between it and Shigella. The organism was desig- nated C27 and considered a member of the family Enterobacte- riaceae. It was later called Aeromonas. The genus Plesiomonas currently resides in the family Vibrionaceae. P shigelloides is a facultatively anaerobic, Gram-negative, oxidase-positive, motile rod. It is readily isolated on enteric media as a lactose nonfer- menter. The primary natural reservoirs are soil, surface water and fish, especially shellfish such as oysters (2). Infections with P shigelloides often cause gastroenteritis, but it has been associated with septicemia, cellulitis, arthritis, cholecystitis, osteomyelitis and meningitis (3,4). Most infections with this organism have been described in Japan (where a great deal of shellfish is eaten), in the Indian subcontinent and in Africa. The vast majority of Caucasians infected with this bacterium have been travellers to high risk areas or those who have recently eaten raw shellfish. A case of P shigelloides sepsis in a neonate with complications of endophthalmitis and multifo- cal intracerebral abscesses is described. To the best of our knowledge this is the first reported case of neonatal P shigel- loides infection in Canada. CASE PRESENTATION A male was born to a healthy mother whose membranes were artificially ruptured 16 h before delivery. Delivery was induced at 36 weeks because of a previous intrauterine death at 38 weeks. The Apgar scores were 8 at 1 min and 9 at 5 mins, and the baby weighed 3410 g (90th percentile). The mother had intermittent diarrhea throughout her preg- CASE REPORT Special Care Nursery, British Columbia’s Children’s Hospital, Vancouver, British Columbia Correspondence: Dr Julian D Eason, Department of Paediatrics, Jersey General Hospital, St Helier, Jersey JE3 1LD. Telephone 01 534 59000, fax 01534 59805, e-mail [email protected]Received for publication January 22, 1996. Accepted May 24, 1996 JD EASON, D PEACOCK. Plesiomonas shigelloides septicemia and meningitis in a neonate. Can J Infect Dis 1996;7(6):380-382. A newborn infant is described who presented with septicemia and meningoencephalitis caused by Plesiomonas shigelloides, a Gram-negative rod belonging to the family Vibrionaceae. This appears to be the first documented case in a neonate in Canada. Despite prompt treatment with appropriate antibiotics, he developed endophthalmitis and lytic brain lesions. Key Words: Endophthalmitis, Meningitis, Neonate, Plesiomonas shigelloides Septicémie et méningite à Plesiomonas shigelloides chez un nouveau-né RÉSUMÉ : On décrit ici le cas d’un nouveau-né atteint de septicémie et de méningite à Plesiomonas shigelloides, bacille gram-négatif appartenant au genre Vibrio. Il s’agirait du premier cas documenté d’infection de ce type au Canada. Malgré l’instauration rapide de l’antibiothérapie nécessaire, l’enfant a développé une endophtalmie et des lésions cérébrales lytiques. 380 CAN JINFECT DIS VOL 7NO 6NOVEMBER/DECEMBER 1996
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Plesiomonas shigelloidessepticemia and meningitis
in a neonate
JULIAN D EASON MBBS MRCP (UK), DONLIM PEACOCK MBCHB FRCPC
Plesiomonas shigelloides was originally isolated in 1947 by
Ferguson and Henderson (1) who noted certain antigenic
similarities between it and Shigella. The organism was desig-
nated C27 and considered a member of the family Enterobacte-
riaceae. It was later called Aeromonas. The genus Plesiomonas
currently resides in the family Vibrionaceae. P shigelloides is a
Received for publication January 22, 1996. Accepted May 24, 1996
JD EASON, D PEACOCK. Plesiomonas shigelloides septicemia and meningitis in a neonate. Can J Infect Dis1996;7(6):380-382. A newborn infant is described who presented with septicemia and meningoencephalitis caused by
Plesiomonas shigelloides, a Gram-negative rod belonging to the family Vibrionaceae. This appears to be the firstdocumented case in a neonate in Canada. Despite prompt treatment with appropriate antibiotics, he developed
Maryland). In addition CSF yielded the same bacterium, which
was oxidase-positive. The organism was presumptively iden-
tified as P shigelloides on the basis of a biochemical assess-
ment with a replica plating technique. Further assessment
with the API 20E identification system (Bio Mérieux, Missouri)
confirmed the speciation. Susceptibility to cefotaxime, ceftriax-
one, cotrimoxazole and gentamicin was established, with re-
sistance to ampicillin. Treatment was continued with
cefotaxime and gentamicin. A fecal culture taken from the
mother three days postpartum failed to grow any pathogens,
and this assessment included a direct search for P shigel-
loides.
At 26 h of age the baby had repeated seizure activity and
required treatment with phenobarbitone, phenytoin and loraz-
epam. Mechanical ventilation was required. Clinical examina-
tion of the pupils revealed a white opacity on the right side.
Ophthalmic examination the following day confirmed the
presence of endophthalmitis with purulent exudate coating
the anterior of the lens and iris. A cranial ultrasound on day 2
revealed multiple focal areas of increased echogenicity in the
frontal lobes and cerebellar folia. Subsequent computed to-
mography (CT) scans on day 4 revealed white matter edema,
and on day 21 revealed multifocal intracerebral cystic and
solid lesions (Figure 1). At one month of age a ventriculoperi-
toneal shunt was inserted for relief of obstructive hydrocepha-
lus, and a 5×5 cm frontal lobe abscess was drained. Micro-
scopic examination of the abscess material demonstrated
necrotic brain tissue. No bacteria were seen, and subsequently
there was no growth on culture. Antibiotic treatment was
continued for a total of six weeks. The child survived to
discharge at the age of two months with signs of severe neuro-
logical damage. Ophthalmic infection resolved, but examina-
tion at three months revealed a vitreous condensation over the
optic nerve head.
Figure 1) Computed tomogram of the cranium: large frontal and multifocal intracerebral abscesses in a neonate infected with Plesimonas shigelloides
CAN J INFECT DIS VOL 7 NO 6 NOVEMBER/DECEMBER 1996 381
P shigelloides septicemia and meningitis
EASON.CHPMon Dec 02 16:24:54 1996
Color profile: DisabledComposite Default screen
DISCUSSIONPlesiomonas is a rare cause of neonatal sepsis and menin-
gitis with high morbidity and mortality. To the best of our
knowledge only 10 other cases have been reported (4-13). The
probable source of infection in this case was the intestinal
infection of the mother. The baby acquired the organism peri-
natally rather than in utero, given the time of onset of symp-
toms. This neonate never had diarrhea. Plesiomonas infection
causing gastroenteritis in adults is well described and is usu-
ally a self-limiting diarrheal illness (14). A total of 24 such
cases were reported in British Columbia in 1994 (15).
P shigelloides may be resistant to ampicillin but is uni-
formly susceptible to third-generation cephalosporins, particu-
larly cefotaxime (10,11,16). Five of the 10 previously described
cases received cefotaxime as one of their antibiotics; four
survived and three had no sequelae. Among the five patients
who did not receive cefotaxime, there was only one survivor,
a child who was treated with penicillin G and gentamicin and
suffered no sequelae (7). The others received either a combi-
nation of ampicillin and an aminoglycoside, or rifampicin.
P shigelloides in the present case was resistant to ampicillin.
Cefotaxime was added as soon as meningitis was sus-
pected.
Endophthalmitis caused by P shigelloides was previously
described in one case, but it was acquired with a penetrating
fishhook injury and necessitated enucleation (17). It seems
that this is a most unusual localization of neonatal bacterial
infection, but it is consistent with a high bacterial load in the
bloodstream, as indicated by the early onset of vasculitic rash
and thrombocytopenia in the present case. Infection resolved
without intraocular administration of antibiotics. Brain ab-
scesses are an unusual complication of meningitis and multi-
ple abscesses even more so. We attributed this complication to
vasculitis leading to thrombosis and cerebral infarction (18).
Gram-negative organisms most often cause necrotizing cere-
britis and abscesses, particularly Proteus, Escherichia and
Citrobacter species (18,19). Necrotizing ependymitis and the
subsequent formation of synechiae are thought to account for
noncommunicating hydrocephalus and the formation of mul-
tiloculated intraventricular cysts seen in this patient.
For an organism that is often described as a sporadic cause
of a self-limiting diarrheal illness, plesiomonas must be re-
garded as highly virulent in the neonate.
ACKNOWLEDGEMENTS: We thank Dr David Scheifele and Dr Nevio
Cimolai for their help in compiling this report.
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