Karamat Ahmed Karamat, Muhammad Zaheer us Saeed, Gohar Zaman, Shahid Ahmad Abasi.
Acinetobacter Meningitis
Pak J Pathol Oct - Dec 1999;10(4):42-4.
Armed Forces Institute of Pathology, Rawalpindi

A 48 years old male sustained head injury in a road traffic accident for which he was admitted to neurosurgical ward. After 07 days of conservative management he was discharged in a fully conscious state but just a day later he developed high grade fever with headache and difficulty in breathing . He was brought to the hospital when he became unconscious. His pulse was 106/min, temperature 101°F and respiratory rate 40/min. No other abnormality was detected on general physical examination. Central nervous system examination revealed an unconscious man with Glasgow coma scale of 8/15. His pupils were equal and reacting to light. Signs of meningeal initation were present. However, no focal deficit was observed. All other systems were normal. Keeping in view the history of head injury, provisional diagnosis of "head injuryeffects of ?" was made and patient was managed by a neurosurgeon in intensive care unit. Inj. chloromycetin 1 gm IN stat vvas given. Inj. gentamycin 80mg 8 hourly was started along with supportive therapy. An urgent CT scan was carried out which revealed multiple fractures affecting right frontal bone, left zygomatic arch and lateral wall of the left orbit. Air and fluid level was noticed in left frontal sinus. The brain parenchyma and ventricles were intact. Other routine investigations vvere normal. Careful clinical assessment and CT scan ruled out requirement for any neurosurgical intervention and the patient was referred to the medical specialist for further management with the diagnosis of "pyogenic meningitis". Inj. claforan (cefotaxime) 2G 8 hourly and Inj. cloxacillin 1G 6 hourly were started along with supportive therapy. The condition of the patient deteriorated further with the passage of time. He was put on ventilator and tracheostomy was performed. Lumbar puncture was done. CSF was turbid with increased proteins (250mg/dl) and decreased glucose (3.6 mg/dl). Cytological examination revealed an enormous increase (2300/cm3) in white cells, which were predominantly polymorphs. Test for globulin was positive. Gram staining showed Gram negative coccobacilli and the findings were conveyed to the treating physician. Growth of a Gram negative bacterium was obtained on culture and biochemical tests were performed. Antibiotic sensitivity revealed that the pathogen was sensitive to amikacin and meropenem and was resistant to cefotaxime. This information was again communicated and the treatment was adjusted accordingly (Inj. amikacin 400mg 12 hourly and Inj.meropenem 2G 8 hourly). The isolate was identified as Acinetobacter baumannii. A detailed final sensitivity report was sent to the hospital which revealed that the isolate was a muitidrug resistant pathogen sensitive only to amikacin and meropenem. The treatment was continued as such along With supportive therapy. The condition of the patient improved gradually and he was discharged with an uneventful recovery.

Category: Case Reports
Keywords: Meningitis. Acinetobacter Meningitis.

Click here for Full Text Article

This article has been viewed 668 times

Submit your Research Synopsis for Free Expert analysis - Search- Feedback - Drug Index
Post and View Comments on this Article