Abstract Details

Title Group D Salmonella Meningitis in the Neonate

Topic Child Neurology and Developmental Neurology

Presentation(s) P5 - Poster Session 5 (8:00 AM-9:00 AM)

Poster/Presentation
Number 6-010

Objective NA

Background Group D Salmonella is a non-typhoid serotype of Salmonella (NTS), which can cause an array of infections including meningoencephalitis, though it is rare accounting for <1% of bacterial meningitis in neonates. This infection is even more rare in non-endemic regions and in those who are immunocompetent.

Design/Methods NA

Results An immunocompetent 6-day-old male neonate born at 37 weeks via vaginal delivery without known pregnancy or delivery complications, presented with poor feeding, jaundice in addition to episodes of apnea and respiratory failure requiring intubation. Blood and CSF cultures grew Salmonella group D of presumed vertical transmission at birth and patient was initiated on a protracted course of ceftazidime. Continuous EEG showed multiple electrographic seizures from the right temporo-parieto-occipital region with diffuse background slowing which prompted emergent neuroimaging. Head ultrasound revealed a large presumed venous hemorrhagic infarction in the right posterior cerebral hemisphere with notable mass effect. Seizures were refractory to initial treatment of phenobarbital, fosphenytoin, levetiracetam and midazolam infusion requiring escalation of treatment to include lacosamide, clobazam, and ultimately ketamine infusion for secondary neuroprotection. Sequential MRI studies later showed abscess cavitation within the hemorrhagic-ischemic lesion, requiring craniotomy and repeated drainage. His hospital course was further complicated by secondary obstructive hydrocephalus from ventriculitis with increased ICP, he underwent an endoscopic third ventriculostomy (ETV). Prior to discharge at 3 months of age he tolerated a wean of phenobarbital without recurrence of seizures on EEG. His discharge exam was significant for central hypotonia and mild left-sided extremity spasticity while breathing on room air and feeding orally.

Conclusions NTS meningitis, is a rare yet severe CNS infection with a high mortality rate, and potential for multiple neurologic complications. Early diagnosis and proactive neuromonitoring in the form of continuous EEG and sequential neuroimaging are essential for prompt treatment to optimize outcomes through secondary injury prevention.

Authors/Disclosures
Melissa Mizerik, DO PRESENTER	Dr. Mizerik has nothing to disclose.
Lin Yao, MD, PhD (Texas Children's Hospital Baylor Medical School)	Dr. Yao has nothing to disclose.
Paisley L. Pauli, DO (Baylor College of Medicine)	Ms. Pauli has nothing to disclose.
Rima El Atrache, MD (Baylor College of Medicine)	Dr. El Atrache has nothing to disclose.
Kristen Fisher, DO (Baylor College of Medicine)	Dr. Fisher has nothing to disclose.
Lisa T. Emrick, MD (Department of Neurology & Developmental Neuroscience)	Dr. Emrick has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Arkema. The institution of Dr. Emrick has received research support from Lysogene. The institution of Dr. Emrick has received research support from PTC. The institution of Dr. Emrick has received research support from Roche. The institution of Dr. Emrick has received research support from NIH.
Brittnie Bartlett-Lee, MD (Baylor College of Medicine)	Dr. Bartlett has nothing to disclose.
Danielle Takacs, MD (Baylor College of Medicine/Texas Children's Hospital)	Dr. Takacs has received publishing royalties from a publication relating to health care.
Steven M. Lazar, MD (Texas Children's Neurology)	Dr. Lazar has nothing to disclose.

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