A case of meningitis caused by Ralstonia insidiosa, a rare opportunistic pathogen
Abstract Background Ralstonia is a genus of Gram-negative opportunistic bacteria that can survive in many kinds of solutions and cause a variety of infections. Ralstonia spp. have increasingly been isolated and reported to cause infections in recent years, thanks to the development of identification...
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| Format: | Article |
| Language: | English |
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BMC
2023-08-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | https://doi.org/10.1186/s12879-023-08506-3 |
| _version_ | 1797453779626360832 |
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| author | Lindan Liao Dan Lin Zhiqiang Liu Yan Gao Kezhang Hu |
| author_facet | Lindan Liao Dan Lin Zhiqiang Liu Yan Gao Kezhang Hu |
| author_sort | Lindan Liao |
| collection | DOAJ |
| description | Abstract Background Ralstonia is a genus of Gram-negative opportunistic bacteria that can survive in many kinds of solutions and cause a variety of infections. Ralstonia spp. have increasingly been isolated and reported to cause infections in recent years, thanks to the development of identification methods such as matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and gene sequencing. However, infections caused by Ralstonia insidiosa are still rare. Only a few cases of respiratory infections and bloodstream infections have been reported, none of which involved meningitis. To the best of our knowledge, this is the first reported case of meningitis caused by R. insidiosa worldwide. It is necessary to report and review this case. Case presentation We report a case of meningitis caused by R. insidiosa following lumbar surgery in China. The patient exhibited symptoms of headache, dizziness, and recurrent fever. The fever remained unresolved after empiric antibiotic therapy with intravenous cefotaxime and vancomycin in the initial days. Cerebrospinal fluid (CSF) culture yielded Gram-negative non-fermentative bacteria, which were identified as R. insidiosa. As there was a lack of antibiotic susceptibility testing results, clinical pharmacists conducted a literature review to select appropriate antibiotics. The patient’s condition improved after receiving effective treatment with intravenous cefepime and levofloxacin. Conclusions Uncommon pathogens, such as R. insidiosa, should be considered in postoperative central nervous system (CNS) infections, particularly in cases with unsatisfactory results of empiric anti-infective therapy. This is the first reported case of meningitis caused by R. insidiosa worldwide. MALDI-TOF MS provides rapid and accurate identification of this pathogen. The antibiotic susceptibility testing results of R. indiosa may be interpreted based on the breakpoints for Pseudomonas spp., Burkholderia cepacia spp., and Acinetobacter spp. Our case presents a potential option for empiric therapy against this pathogen, at least in the local area. This is crucial to minimize the severity and mortality rates associated with meningitis. Standardized antibiotic susceptibility testing and breakpoints for the Ralstonia genus should be established in the future as cases accumulate. Cefepime and levofloxacin may be potential antibiotics for infections caused by R. indiosa. |
| first_indexed | 2024-03-09T15:27:48Z |
| format | Article |
| id | doaj.art-f09ba6d3cc4f4a65ac85a3a904c494ba |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-03-09T15:27:48Z |
| publishDate | 2023-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-f09ba6d3cc4f4a65ac85a3a904c494ba2023-11-26T12:27:11ZengBMCBMC Infectious Diseases1471-23342023-08-012311810.1186/s12879-023-08506-3A case of meningitis caused by Ralstonia insidiosa, a rare opportunistic pathogenLindan Liao0Dan Lin1Zhiqiang Liu2Yan Gao3Kezhang Hu4Department of Clinical Pharmacy, The First People’s Hospital of NeijiangDepartment of Clinical Pharmacy, The First People’s Hospital of NeijiangDepartment of Clinical Pharmacy, The First People’s Hospital of NeijiangDepartment of Clinical Pharmacy, The First People’s Hospital of NeijiangDepartment of Clinical Pharmacy, The First People’s Hospital of NeijiangAbstract Background Ralstonia is a genus of Gram-negative opportunistic bacteria that can survive in many kinds of solutions and cause a variety of infections. Ralstonia spp. have increasingly been isolated and reported to cause infections in recent years, thanks to the development of identification methods such as matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and gene sequencing. However, infections caused by Ralstonia insidiosa are still rare. Only a few cases of respiratory infections and bloodstream infections have been reported, none of which involved meningitis. To the best of our knowledge, this is the first reported case of meningitis caused by R. insidiosa worldwide. It is necessary to report and review this case. Case presentation We report a case of meningitis caused by R. insidiosa following lumbar surgery in China. The patient exhibited symptoms of headache, dizziness, and recurrent fever. The fever remained unresolved after empiric antibiotic therapy with intravenous cefotaxime and vancomycin in the initial days. Cerebrospinal fluid (CSF) culture yielded Gram-negative non-fermentative bacteria, which were identified as R. insidiosa. As there was a lack of antibiotic susceptibility testing results, clinical pharmacists conducted a literature review to select appropriate antibiotics. The patient’s condition improved after receiving effective treatment with intravenous cefepime and levofloxacin. Conclusions Uncommon pathogens, such as R. insidiosa, should be considered in postoperative central nervous system (CNS) infections, particularly in cases with unsatisfactory results of empiric anti-infective therapy. This is the first reported case of meningitis caused by R. insidiosa worldwide. MALDI-TOF MS provides rapid and accurate identification of this pathogen. The antibiotic susceptibility testing results of R. indiosa may be interpreted based on the breakpoints for Pseudomonas spp., Burkholderia cepacia spp., and Acinetobacter spp. Our case presents a potential option for empiric therapy against this pathogen, at least in the local area. This is crucial to minimize the severity and mortality rates associated with meningitis. Standardized antibiotic susceptibility testing and breakpoints for the Ralstonia genus should be established in the future as cases accumulate. Cefepime and levofloxacin may be potential antibiotics for infections caused by R. indiosa.https://doi.org/10.1186/s12879-023-08506-3RalstoniaRalstonia insidiosaMeningitisInfection |
| spellingShingle | Lindan Liao Dan Lin Zhiqiang Liu Yan Gao Kezhang Hu A case of meningitis caused by Ralstonia insidiosa, a rare opportunistic pathogen BMC Infectious Diseases Ralstonia Ralstonia insidiosa Meningitis Infection |
| title | A case of meningitis caused by Ralstonia insidiosa, a rare opportunistic pathogen |
| title_full | A case of meningitis caused by Ralstonia insidiosa, a rare opportunistic pathogen |
| title_fullStr | A case of meningitis caused by Ralstonia insidiosa, a rare opportunistic pathogen |
| title_full_unstemmed | A case of meningitis caused by Ralstonia insidiosa, a rare opportunistic pathogen |
| title_short | A case of meningitis caused by Ralstonia insidiosa, a rare opportunistic pathogen |
| title_sort | case of meningitis caused by ralstonia insidiosa a rare opportunistic pathogen |
| topic | Ralstonia Ralstonia insidiosa Meningitis Infection |
| url | https://doi.org/10.1186/s12879-023-08506-3 |
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