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Year : 2021  |  Volume : 16  |  Issue : 2  |  Page : 168-169

Brain abscess due to Enterobacter sakazakii in a neonate

1 Sri Balaji Hospital, Chennai, Tamil Nadu, India
2 Nizwa Hospital, Nizwa, Oman

Date of Submission09-Jun-2020
Date of Decision27-Aug-2020
Date of Acceptance01-Oct-2020
Date of Web Publication19-Jul-2021

Correspondence Address:
Dr. Srinivasan Sreeramulu Uddanapalli
3A Malavika Apartments, New No 70, 3rd Main Road, Gandhinagar, Adyar, Chennai 600020, Tamil Nadu.
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jpn.JPN_149_20

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How to cite this article:
Uddanapalli SS, AlSheulli HA. Brain abscess due to Enterobacter sakazakii in a neonate. J Pediatr Neurosci 2021;16:168-9

How to cite this URL:
Uddanapalli SS, AlSheulli HA. Brain abscess due to Enterobacter sakazakii in a neonate. J Pediatr Neurosci [serial online] 2021 [cited 2023 Dec 5];16:168-9. Available from: https://www.pediatricneurosciences.com/text.asp?2021/16/2/168/321778

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.[2],[3] 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 Scientific Name Search . 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

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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

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

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I wish to acknowledge the support given by Medical Director, Nizwa hospital, Nizwa, Oman.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Farmer JJ III, Asbury MA, Hickman FW, Brenner DJ; the Enterobacteriaceae Study Group. Enterobacter sakazakii: a new species of “Enterobacteriaceae” isolated from clinical materials. Int J Syst Bacteriol 1980;30:569-84.  Back to cited text no. 1
Muytjens HL, Zanen HC, Sonderkamp HJ, Kollée LA, Wachsmuth IK, Farmer JJ 3rd. Analysis of eight cases of neonatal meningitis and sepsis due to Enterobacter sakazakii. J Clin Microbiol 1983;18:115-20.  Back to cited text no. 2
Bowen AB, Braden CR. Invasive Enterobacter sakazakii disease in infants. Emerg Infect Dis 2006;12:1185-9.  Back to cited text no. 3
Ries M, Deeg KH, Heininger U, Stehr K. Brain abscesses in neonates––report of three cases. Eur J Paediatr 1993;152: 745-46.  Back to cited text no. 4


  [Figure 1], [Figure 2], [Figure 3]


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