Braın Abscess Due To Proteus Mirabilis Meningitis As A Complication Of Mastoiditis: Case Report

Year 2010, Volume: 12 Issue: 3, 72 - 75, 01.12.2010

Cemal Üstün Mehmet Faruk Geyik Mehmet Reşit Önen

Abstract

Meningitis and intracranial abscess due to Proteus mirabilis is seen especially in the neonatalperiod and among the patients with immune deficiency. It was learned that 35 years old malepatient who applied to the emergency room with ongoing fever, nausea and vomiting for threedays have had their upper left jaw tooth out 10 days ago. As clinical and laboratory to patientswith acute bacterial meningitis empirical ceftriaxone 2x2 gr/day parenteral was started. Thecranial MR of the patient, that has P. mirabilis producing in their blood and cerebrospinal fluid(CSF) culture, was taken at the seventh day of hospitalization as his complaints started again.In the MR, abscess was detected in the left temporal brain of the patient and a surgical treatmentwas applied. Complete healing was seen eight week treatment with antibiotics after surgery.During application it was though that meningitis has occurred due to the dental surgery, howeverafter the temporal BT, mastoiditis was detected. It was thought that meningitis and brain abscessdeveloped on the patient was caused by mastoiditis. Even with sensitive antibiotics if norecovery is observed in patients with meningitis, intracranial abscess should be considered, alsoit should not be forgotten that in adults and patients with no immune deficiency meningitis dueto P. mirabilis may develop

Keywords

Proteus mirabilis, meningitis, brain abscess

Mastoiditin Komplikasyonu Sonucu Gelişen Proteus Mirabilis Menenjitine Bağlı Beyin Absesi: Olgu Sunumu

Abstract

Proteus mirabilis’e bağlı menenjit ve intrakraniyal apse gelişimi, özellikle neonatal dönemdeve immün yetmezliği olan bireylerde görülmektedir. Acil servise; üç gündür devam eden ateş,bulantı ve kusma yakınmalarıyla başvuran 35 yaşında erkek hastanın, 10 gün önce sol üstçeneden diş çektirdiği öğrenildi. Klinik ve laboratuar olarak akut bakteriyel menenjit ile uyumluolan hastaya ampirik seftriakson 2x2 gr/gün parenteral başlandı. Kan ve beyin omurilik sıvısı(BOS)’nda P. mirabilis üreyen hastanın; yatışın yedinci gününde yakınmalarının tekrar başlamasıüzerine, kranial MR çekildi. MR’da sol temporalde beyin apsesi saptanan hastaya cerrahi tedaviuygulandı. Cerrahi sonrası sekiz haftalık antibiyotik tedavisi ile tamamen iyileşme görüldü.Başvuru sırasında menenjitin dental cerrahiye bağlı oluştuğu düşünülen hastada, daha sonraçekilen temporal BT sonrası mastoidit tespit edildi. Olguda gelişen menenjit ve beyin absesininmastoidite bağlı olduğu düşünüldü. Menenjit olgularında, duyarlı antibiyotiğe rağmen düzelmesaptanmaması durumunda intrakranial apse düşünülmeli, erişkin ve immün yetmezliği olmayanolgularda da P. mirabilis’e bağlı menenjit gelişebileceği unutulmamalıdır

Keywords

Proteus mirabilis, menenjit, beyin apsesi

References

• Farmer JJ, Kelly MT: Enterobacteriaceae. In Balows A, Hausler WJ, Herrmann KL Isenberg HD, Shadomy HJ (eds): Manuel of Clinical Microbiology. 5th Ed. American Society for Microbiology. Washington DC. pp: 360-83, 1991.
• Chang W N, Tsai Y C, Chien C C, Huang C R, Lu C H: Frequent association with neurosurgical conditions in adult Proteus mirabilis meningitis: report of five cases. Clinical Neurology and Neurosurgery. 104: 121–124, 2002.
• Rosenblum ML, Hoff JT, Norman D: Nonoperative Treatment of Brain Abscess in selected High-Risk Patients. J Neurosurgery 52:217-25, 1980.
• Chang Chien HY, Chiu NC, Li WC, Huang FY: Characteristics of neonetal bacteriel menengitis in a teaching hospital in Taiwan from 1984-1997. J microbiol immunol infect. 33(2):100-4, 2000.
• Takeshita M, Kagawa M, Yato S, Izawa M, Onda H, Takakura K, Momma K: Current treatment of brain abscess in patients with conjenital cyanotic heart disease. Neuosurgery. Dec (41(6): 1270-9, 1997.
• Rau C S, Chang W N, Lin Y C, Lu C H: Brain abscess caused by aerobic Gram-negative bacilli: clinical features and therapeutic outcomes. Clinical Neurology and Neurosurgery. 105: 60-65, 2002.
• Tunkel AR, Scheld WM. Acute meningitis. In Mandell GL, Bennet JE, Dolin R (eds): Principles and Practice of Infectious Diseases. 4th Ed. Churchill Livingstone. New York, pp. 831-65, 1995.
• Gray PH, O'Reilly C: Neonatal proteus mirabilis meningitis and cerebral abscess : diagnosis by real-time ultrasound. J Clin Ultrasound. Sep; 12(7):441-3, 1984.
• Okubo T, Shirane R, Mashiyama S. No Shinkei Geka. Proteus mirabilis brain abscess in a neonate. Mar;12(3 Suppl):395- 400, 1984
• Cihangiroğlu M, Çelik İ, Akdemir İ, Artaş H, Akbulut A: A case of non-traumatic pneumocephalus associated with otogenic proteus mirabilis cerebellar abscess. Fırat Tıp Dergisi. 13(2): 137-140, 2008.
• Elaldı N, Ergür A T, Alagözlü H, Bakıcı M Z: Meningitis Caused by Proteus mirabilis: The Evaluation of a Case. C. Ü. Tıp Fakültesi Dergisi. 24 (1): 33- 35, 2002.
• Cherubin CE, Marr JS, Sierra MF, Becker S: Listeria and gram negative bacillary meningitis in New York city, 1972-1979. Frequent causes of meningitis in adults. Am J Med 71(2): 199- 209, 1981.
• Durmaz G, Bolatlı T, Kiraz N, Koçoğlu T, Akgün Y, Akşit F: Osmangazi Üniversitesi Tıp Fakültesinde 1982-1993 yılları arasında değerlendirilmesi. Mikrobiyoloji Bülteni. 28:223-7, 1994.
• Kangsanarak J, Navacharoen N, Fooanant S, Ruckphaopunt K: Intracranial complications of suppurative otitis media: 13 years' experience. Am J Otol 16 (1): 104-9, 1995.
• Fuchs PC, Barry AL, Brown SD: Survey of antimicrobial activity of four commonly used third generation cephalosporins tested against recent bacterial isolates from ten American medical centers and assessment of disk diffusion test performance. AST Surveillance Group. Diagn Microbiol Infect Dis. 24:213-219, 1996.
• Thornsberry C, Yee YC. Comperative activity of aight antimicrobial agents against clinical bacterial isolates from the United States measured by two methods. Am J Med. 24:26- 38, 1996.
• Black P, Graybill JR, Charache P: Penetration of Brain Abscess by Systemically Administered Antibiotics. J Neurosurgery 38: 705-9, 1973
• Yao JDC, Moellering RC Jr: Antibacterial agents. In: Murray PR, Baron EJi Pfaller MA, Jorgensen JH, Yolken RH. Ed. Manual of Clinical Microbiology. 8th ed. Washington DC: ASM; 2003 p.1039-1074.
• Kurtoglu MG, Bozkurt H, Güdücüoğlu H, Bayram Y, Berktaş M: Klinik örneklerden izole edilen Proteus mirabilis suşlarının antimikrobial ajanlara duyarlılıkları. Genel Tıp Dergisi 18(1): 23-26, 2008.
• Mampalam TJ, Rosenblum ML: Trends in the management of bacterial brain abscess: A rewiev of 102 cases over 17 years. Neurosurgery. 23: 451-458, 1988.
• Osenbach RK, Loftas CM. Diagnosis and management of brain abscess. Neurosurgery Clin North Am. 3:403-420, 1992.
• Çavuşoğlu H, Can S M, Genç H A, Aydın Y: İntrakraniyal apselerde cerrahi tedavi. Türk Nöroşirürji Dergisi. 15(2): 152- 160, 2005.
• Xiao F, Tseng M Y, Teng L J, Tseng H M, Tsai J C: Brain abscess: clinical experience and analysis of prognostic factors Surgical Neurology 63: 442–450, 2005.