Proteus Mirabilis Septicemia and Meningitis in a Neonate

Abstract

A 6-day-old premature baby boy presented in a pediatric clinic for severe jaundice, poor feeding and lethargy. He was born to a 24-year-old mother who was primigravida. Pregnancy was complicated by gestational diabetes, appropriately treated chlamydial infection, oligohydramnios and inadequate prenatal care. On physical examination, he was hypotonic and irritable with significant jaundice seen from his head to his lower extremities. Transcutaneous bilirubin obtained in clinic showed a level of 14 mg/dL. A serum bilirubin level was immediately ordered and it confirmed an elevated unconjugated bilirubin level of 18.9 mg/dL. He was admitted to the inpatient unit and a full septic work-up was initiated. Appropriate antibiotics were administered to cover for the most common pathogen involved in neonatal sepsis. A few hours into the admission, his condition deteriorated requiring intubation for multiple consecutive apneic episodes and seizure-like activity. Initial laboratory evaluation included an abnormal white blood cell count of 2,600/L with left shift, elevated lactic acid of 9 mmol/L and a low bicarbonate level of 16 mmol/L further confirming acidosis. Analysis of cerebrospinal fluid revealed a white blood cell count of > 300/L, low glucose with a level of 7 mg/dL and elevated protein level of 645 mg/dL. Due to his rapid clinical deterioration a few hours into the admission, a computed tomography scan of the brain was obtained. Computed tomography scan of brain showed significant damage to brain parenchyma consistent with anoxic brain injury. He expired on his second day of admission. Proteus mirabilis was the causative agent.




J Med Cases. 2014;5(4):245-247
doi: https://doi.org/10.14740/jmc1290w