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Whitney Marvin, MD
Attending Physician
Medical University of South Carolina
Charleston, South Carolina, United States
Disclosure information not submitted.
Title: A Rare Case of Neonatal Meningoencephalitis, or Is It?
Case Report Body:
Introduction: Neonatal meningoencephalitis is a common entity but has rarely been attributed to Paenibacillus thiaminolyticus infection. This rod-shaped bacterium has only recently been noted as a pathogen in humans, causing blood stream infections in certain compromised populations or in post mortem assessments. We describe a life-threatening infection in a neonate with meningoencephalitis who was treated successfully with combination antibiotics and survived.
Description: A 16-day-old full term infant presented with poor feeding and fevers. Initial CSF studies were consistent with bacterial meningitis and the gram stain showed gram negative rods; he was started on ampicillin and gentamicin. Within 24 hours he had seizures that required multiple antiepileptics and intubation secondary to apnea. His antibiotics were changed to ampicillin, ceftazidime, and acyclovir. His exam was concerning for decreased left sided movement, and an MRI showed right sided ventriculitis, encephalitis, and cystic changes with restricted diffusion in the thalamus and corona radiata consistent with acute infarction. The pathogen was unable to be identified initially and the sample was sent to a reference laboratory. Due to continued fevers he had multiple CSF samplings, and antibiotics were broadened to continuous meropenem. The organism was identified as P thiaminolyticus on day of life (DOL) 31. Antibiotic susceptibility was available on DOL 42, but fortunately he had great improvement and completed 6 weeks total of antibiotics. Despite this invasive infection he met all expected milestones at discharge and by 9 months of life.
Discussion: This report will review P thiaminolyticus and possible treatment regimens. This bacterium is difficult to grow in culture and a 2021 case series from Uganda reported P thiaminolyticus was found in a significant number of CSF samples obtained during shunt placements, suggesting that it could be an underrecognized cause of neonatal meningitis. Consideration for further microbiologic testing should be considered especially in cases of culture negative meningoencephalitis.