Abstract
Elizabethkingia meningoseptica is a rare but well-recognised cause of neonatal meningitis. Reported outbreaks have involved very few cases. We describe the management and outcome of a relatively large outbreak of E.meningoseptica neonatal meningitis From August 2002 to December 2003, eight cases of meningitis caused by E. meningoseptica occurred among babies admitted to the neonatal ward of Jawarhlal Nehru hospital, Mauritius. In all cases, the organism was isolated from the cerebrospinal fluid. Infection control measures were re-emphasized after each case and environmental swabs were cultured on several occasions. The affected babies were aged 6 to 20 days (mean age of 10 days). Seven of the babies weighed < 2,500 g. All CSF isolates had the same antibiotic susceptibility pattern. Apart from one baby who died shortly after admission, all cases responded to treatment with intravenous piperacillin and oral rifampicin for three weeks. Hydrocephalus developed in two babies and was subsequently fatal in one case. At follow-up of the other cases, one baby had severe neurological sequelae but a full recovery was observed in the other four cases. The source of the outbreak could not be established conclusively. The outcome was better than what has been reported in the medical literature.Prompt identification of the causative organism and initiation of appropriate antimicrobial therapy is essential. The combination of piperacillin and rifampicin should be considered an option for the treatment of E. meningoseptica neonatal meningitis if supported by properly performed antibiotic susceptibility test results.
Highlights
Elizabethkingia meningoseptica is a rare but well-recognised cause of neonatal meningitis
We describe an outbreak in a neonatal ward of E. meningoseptica meningitis which affected eight babies over a sixteen-month period
Three of the neonates were admitted with meningitis after having been discharged home from the neonatal ward whereas the other five had been in the ward from birth until they developed meningitis
Summary
Elizabethkingia meningoseptica is a rare but well-recognised cause of neonatal meningitis. Elizabethkingia meningoseptica, formerly known as CDC group IIa, Flavobacterium meningosepticum and Chryseobacterium meningosepticum, is Gramnegative, rod-shaped bacterium widely distributed in nature, in soil and water [1] It was first recognized as a cause of neonatal meningitis by Elizabeth King in 1959 [2]. E. meningoseptica meningitis occurs mainly in premature babies in the first two weeks of life It is fatal in more than half of the cases and sequelae are common among the survivors [1,3]. E. meningoseptica meningitis usually accounts for a very small proportion of neonatal meningitis, accurate diagnosis is important because the organism is usually resistant to multiple antibiotics, including ampicillin, cefotaxime and gentamicin, largely used in the empirical treatment of this life-threatening infection
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