2023-10-13 16:53:30
Elderly Patient Diagnosed with Meningoencephalitis Caused by a Rare Bacterium
An elderly patient presented with speech problems and confusion at Thun Hospital, where doctors were surprised to diagnose her with meningoencephalitis. The 76-year-old woman had experienced symptoms such as fever, headache, confusion, and impaired speech motor skills (dysarthria) for about 24 hours before being admitted.
The patient had a medical history that included a successfully treated pancreatic tumor, Parkinson’s disease, arterial hypertension, and type 2 diabetes. However, her current medications, which included levodopa plus decarboxylase inhibitors, mirtazapine, Rivotril®, insulin, pancreatic enzymes, esomeprazole, ASA, metoprolol, and enalapril, did not provide any clues to explain her acute symptoms. Additionally, there were no indications of infections from travel, close relatives, or animals.
During the initial examination, the patient showed a Glasgow Coma Score of 14, indicating no impaired consciousness. Laboratory findings revealed leukocytosis and increased C-reactive protein, while examination of cerebrospinal fluid showed high white blood cell count, elevated protein levels, and elevated lactate level. A computed tomography scan of the brain did not show any relevant pathological findings, leading doctors to suspect meningoencephalitis.
The patient was initially treated with empirical antibiotic therapy using ceftriaxone and amoxicillin, along with antiviral therapy using acyclovir. Dexamethasone was also administered. Although the patient responded well to the treatment, some symptoms such as dysarthria, ataxia, mild paresis of the left leg, and meningismus persisted after a few days.
Further tests, including a polymerase chain reaction of the cerebrospinal fluid, did not yield any conclusive results. However, the blood cultures finally provided a surprising finding. The microbiology laboratory identified Flavobacterium species, specifically Flavobacterium lindanitolerans, which is highly unusual and has not been previously documented in human medicine.
Flavobacterium species are typically found in freshwater fish or in the soil and are known to cause severe necrosis in fish. While infections in humans are extremely rare, the Swiss doctors and microbiologists were able to confirm the first documented case of meningoencephalitis caused by Flavobacterium lindanitolerans. The patient’s treatment was adjusted based on information from the literature, replacing amoxicillin, dexamethasone, and ceftriaxone with sulfamethoxazole/trimethoprim in combination with ciprofloxacin.
Following the adjustment in treatment, the patient responded well and was able to leave the hospital after 14 days. She will continue to receive geriatric rehabilitation to further improve her mental status, dysarthria, and gait.
The case is unique because of the rarity of Flavobacterium lindanitolerans infections in humans. These bacteria are commonly found in the environment, including soil, fresh and sea water, and infected fish. However, cases of meningoencephalitis caused by this bacterium have not been previously reported in the literature. The successful identification of the bacterium was attributed to the use of MALDI-TOF mass spectrometry, a modern method for bacterial identification.
The route of entry for the bacteria into the patient’s body remains unknown, highlighting the need for further research and surveillance regarding rare pathogens. This case report serves as an important reminder of the potential for unexpected triggers in diagnosing and treating patients with uncommon infections.
Source:
Zurbuchen et al.: First Case of Meningoencephalitis and Bacteraemia with Flavobacterium Lindanitolerans. Eur J Case Rep Intern Med 2023. doi: 13;10(8):0039]
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