A Case of Meningitis Caused by Mycobacterium abscessus in a Paediatric Patient

D R Gayathri Devi,S Vishnu Prasad,H B Mallikarjuna,Anusha Chaturvedi

doi:10.4236/jtr.2015.32008

D R Gayathri Devi, S Vishnu Prasad + Show 2 more

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https://doi.org/10.4236/jtr.2015.32008

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Abstract

Mycobacterium abscessus, a rapidly growing and potentially pathogenic Mycobacterium, is an environmental contaminant and is commonly found in tap water supplies. We report a case of M. abscessus meningitis following VP shunt insertion. A 9-year-old male patient with previous history of aqueductal stenosis and hydrocephalus with VP shunt in situ, presented with pain abdomen of 10 days duration. Investigations revealed multiple mesenteric lymph nodes with impacted VP shunt tip within the omentum. Ascitic fluid and CSF tap showed Acid-Fast Bacilli, later confirmed to be M. abscessus. The patient was treated with Clarithromycin and Amikacin, leading to resolution of the infection. To the best of our knowledge, this is the first reported case of M. abscessus meningitis in an immunocompetent individual. We discuss the possible sources of infection and therapeutic challenges. It is of utmost importance to consider, with high index of suspicion, nontubercular Mycobacteria as the causative organism in patients, who do not respond to regular anti-tubercular regimen.

Highlights

Mycobacterium abscessus, formerly Mycobacterium chelonae subspecies abscessus, is a distant relative of My-How to cite this paper: Devi, D.R.G., Mallikarjuna, H.B., Chaturvedi, A. and Prasad, S.V. (2015) A Case of Meningitis Caused by Mycobacterium abscessus in a Paediatric Patient
We report a case of isolated tubercular meningitis due to Mycobacterium abscessus and the dissemination to the peritoneal cavity via a Ventriculo-Peritoneal (VP) shunt
Lumbar puncture was done and CSF sent for analysis, Gram’s stain showed occasional WBCs and no organisms, while Ziehl Neelsen (ZN) stain was positive for Acid Fast Bacilli (Figure 3)

Summary

Introduction

Mycobacterium abscessus, formerly Mycobacterium chelonae subspecies abscessus, is a distant relative of My-. (2015) A Case of Meningitis Caused by Mycobacterium abscessus in a Paediatric Patient. This organism constitutes Group IV, i.e. Rapid Growers of Runyon’s Classification of Non Tubercular Mycobacteria (NTM) [1]. M. abscessus is an environmental pathogen, found in soil, water and dust [2]. It is capable of contaminating water supplies, reagents and water solutions in hospitals and has the ability to survive in nutritionally deficient environments over a wide range of temperature [3]. We report a case of isolated tubercular meningitis due to Mycobacterium abscessus and the dissemination to the peritoneal cavity via a Ventriculo-Peritoneal (VP) shunt

Case Report

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