Brain Abscess Due to Enterobacter sakazakii in a Neonate.

Enterobacter sakazakii was described in 1980 as a new member of the Enterobacteriaceae family.[1] Infants with meningitis due to E. sakazakii were generally less than 1 week old.[23] The first signs of sepsis appear between the 4th and 8th day of life. The infants tend to be of greater gestational age and birth weight.[3] Reviewing the literature between 1958 to 2005, Bowen and Braden[3] reported seven cases of neonatal brain abscess due to E. sakazakii.[4]

Here we report the 8th case. A 6-day-old female child who was delivered normally with a birth weight of 3.2 kg, presented with altered sensorium and high-grade fever of 3 days. Examination revealed a hypoactive child with tense anterior fontanelle. Blood and cerebrospinal fluid (CSF) culture showed the growth of E.sakazakii. Cranial ultrasonography revealed multiple hypoechoic areas within the frontal lobes. During her treatment, she developed repeated secondary generalized seizures. So, she was put on a ventilator.

Computerized tomography (CT) contrast brain scan revealed a non-enhancing diffuse hypodense region with mass effect in the left frontoparietal lobes. On the right side, there was a similar hypodense region without mass effect. Meninges and ventricular walls showed minimal enhancement suggestive of meningitis and ventriculitis. A diagnosis of bilateral frontal focal cerebritis with mass effect was considered. She was initially treated conservatively with parenteral antibiotic meropenem. The follow-up contrast CT brain performed at 3 weeks, showed brain abscesses. The left frontoparietal abscess measured 77 mm × 53 mm × 78 mm. There was a second abscess in the left parieto-occipital lobe which measured 19 mm × 37 mm × 44 mm. A third abscess was present on the right frontal lobe that measured 51 mm × 18 mm × 71 mm [Figure 1]. Repeated serial aspirations were performed on both sides. The culture of the pus revealed E. sakazakii. She was gradually weaned off the ventilator.

Figure 1

Preop contrast CT scan brain showing multiple bilateral frontoparietal abscesses

Serial imaging scans [Figure 2] showed a progressive decrease in the size of the brain abscesses. Antibiotic meropenem was given intravenously for 6 weeks followed by ciprofloxacin orally for 4 weeks. A follow-up CT brain showed evidence of multiloculated hydrocephalus [Figure 3]. Ventriculo-peritoneal shunt surgery was performed for the hydrocephalus. At the end of 2 years, the child was still retarded. We report this case to highlight the occurrence of E. sakazakii as a cause of brain abscess in the neonate.

Figure 2

Post-aspiration CT brain showing reduction in the size of the abscess cavity on the left side while enlarged abscess on the right side

Figure 3

Follow-up contrast CT brain after 3 months showing the occurrence of multiloculated hydrocephalus

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