Elizabethkingia miricola Causes Intracranial Infection: A Case Study

Abstract

Background: Elizabethkingia miricola is a rarely encountered bacterium in clinical practice. It is a rare gram-negative rod-shaped bacterium associated with lung and urinary tract infections, but never found in cerebrospinal fluid. This paper reports a case of an adult patient infected by E. miricola via an unknown route of infection causing a severe intracranial infection. Elizabethkingia miricola was detected by culture and Metagenomic next generation sequencing in CSF. Early identification of this strain and treatment with sensitive antibiotics is necessary to reduce morbidity and mortality. Case Report: A 24-year-old male was admitted to a West China Hospital because of headache and vomiting for 2 months. Symptom features included acute onset and long duration of illness. Notably, headache and vomiting were the primary neurological symptoms. Routine cerebrospinal fluid culture failed to identify the bacterium; however, Elizabethkingia miricola bacterium was detected via second-generation sequencing techniques. Elizabethkingia miricola was found to be a multi-drug resistant organism, hence, treatment with ceftriaxone, a commonly used drug for intracranial infections was ineffective. This strain eventually caused severe intracranial infection resulting in the death of the patient. Conclusion: In summary, this study comprehensively describes a case of an adult patient infected by E. miricola and discusses its early identification as well as application of sensitive antibiotics in the emergency setting.

Keywords: Elizabethkingia miricola; bacterial infection; case report; intracranial infection; neurology.

Figure 1

The head CTA scan of patient (Apr 19, 2021). Slightly high-density nodules were observed in the left frontal lobe and temporal lobe. The largest nodules were located in the frontal lobe, with a size of about 2.8 × 2.4 cm (Arrow indicating part). Shadow shuttling of arterial vessels was observed at the edge, without obvious thickening and tortuosity. The intraventricular system was hydrocephalic and dilated, accompanied by interstitial cerebral edema. Some sulci in bilateral cerebral hemispheres became narrow and unclear, and the density of tentorium cerebellum increased slightly.

Figure 2

Culture plates showing the growth of Elizabethkingia miricola. The blood plate colony is yellow, translucent, round, with neat edges (A). Gram-negative bacilli can be seen 1,000 times under the oil lens of blood culture (B).

Figure 3

The 16s sequencing comparison result of blood culture samples from patients was Elizabethkingia, and the final sequencing result was Elizabethkingia miricola (A). NCBI comparison of 16S sequencing results (B). Primer: 27F AGTTTGATCMTGGCTCAG; Reverse: 1492R GGTTACCTTGTTACGACTT. The 16S amplified sequence of the sample was 100% compared with that of Elizabethkingia miricola.