Multiple brain abscesses caused by Serratia marcescens in preterm newborn

Abstract

Background: Brain abscesses are possible but very uncommon complications of bacterial sepsis and meningitis in neonates. We report a case of multiple brain abscesses in a preterm neonate as a complication of Serratia marcescens sepsis. Case: The female preterm weighing 1990 g was delivered by cesarean section at 32 weeks of gestation. Apart from moderate respiratory distress syndrome (RDS), the baby was in a good condition with no indicators of perinatal infection. On the 3rd day of life, the clinical status deteriorated and the sepsis screen was positive. The baby was intubated and, along with other intensive measures, treated with high doses of vancomycin and imipenem. Serattia marcescens was isolated in hemoculture. The baby clinicaly improved in the following days, but the cranial ultrasound revealed multiple hypoechoic lesions in parietal lobes bilaterally. Magnetic resonance imaging (MRI) of the brain showed multiple (five) hypodense lesions with the peripheral enhancement suggestive of intra-parenchymal abscesses. The neurosurgical consilium suggested conservative treatment with antibiotics and weekly neuroimiging follow-up. The antibiotic treatment was conducted for a total of 8 weeks. The final MRI showed a total regresion of previous abscesses with the formation of small cavitations. The clinical and neurological examination of the baby was normal as was the EEG. The baby was discharged with a recommendation of neurological follow-up. Conclusion(s): A multidisciplinary team approach, including neurosurgeons, neonatologists and infectious disease specialists, is needed for a decision on treatment of brain abscesses in neonates. Serial imaging is important in the assessment of the efficacy of treatment.Copyright © 2018 Walter de Gruyter GmbH, Berlin/Boston.