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• W4295693276 abstract "To the Editors: A 5-week-old female born by C-section at 34 weeks of gestational age due to preeclampsia, with uncomplicated prenatal care, presented to an outside hospital with a 4-day-history of fever and seizure. The infant had a normal newborn screen and had been exclusively fed with formula since birth. On examination, she was febrile with a poor suck and hypertonia. Cerebrospinal fluid (CSF) analysis showed WBC of 134/mm3 (57% monocytes) with 5 red blood cells (RBC) 5/mm3, protein of 1044 mg/dL and glucose <20 mg/dL. Ampicillin, ceftazidime and vancomycin were initiated. CSF culture yielded Paenibacillus species by matrix-assisted laser desorption/ionization-time of flight. An MRI of the brain with and without contrast revealed extensive cerebritis with areas of tissue necrosis and central liquification with abscesses and cystic encephalomalacia (Fig. 1). Antibiotics were stopped and the patient was discharged to receive home hospice care on day 6 of hospitalization.FIGURE 1.: A: Brain MRI with and without contrast. B: sample obtained from the fontanelle.Two days following discharge, her parents presented to our institution to resume full medical care. CSF analysis from a transfontanelle bedside aspiration showed: glucose 32 mg/dL, protein 1869 mg/dL, RBC 1900/mm3, WBC cells 46/mm3, (57% neutrophils, 27% lymphocytes and 16% monocytes). CSF cultures remained negative but 16S rRNA sequencing (University of Washington Medical Center Laboratories) was positive for Paenibacillus spp. Antimicrobials were narrowed and the patient completed a 6-week course of IV ampicillin therapy. She later developed significant hydrocephalus requiring an endoscopic third ventriculostomy at 5 months. We obtained a complete sequence of the organism that initially grew outside the facility using a hybrid assembly approach of short- and long-read sequencing. Phylogenetic analyses indicated that when compared to 244 16SrRNA Paenibacillus species available, all 8 copies found in our genome clustered most closely with Paenibacillus dendritiformis (Table 1, Supplemental Digital Content 1, https://links.lww.com/INF/E805). Paenibacillus spp. was originally classified under the genus Bacillus until 1993, when they were segregated based on phylogenetic analysis of 16S rRNA.1 A few cases of Paenibacillus spp. infections have been described in pediatrics. DeLeon et al.2 reported a case of bacteremia and meningitis due to Paenibacillus alvei in a premature neonate resulting in cerebritis and cystic encephalomalacia and death. Hunt et al.3 reported a case of premature infant death due to probable Paenibacillus thiaminolyticus sepsis and meningitis. A recent case4 of P. dendritiformis meningitis in a 31-day-old premature infant who subsequently developed hemorrhagic meningoencephalitis, brain abscesses and encephalomalacia. A possible association of Paenibacillus spp. with postinfectious hydrocephalus in infants in sub-Saharan Africa has been reported.5 Most Paenibacillus spp. isolates are resistant to penicillin,6,7 susceptible to cefotaxime, gentamicin, rifampicin and vancomycin with the variability of sensitivity against erythromycin.7 However, in our case, an antibiogram using E-testing showed a low minimal inhibitory concentration (MIC) to penicillin and high MIC to vancomycin (Material 1, Supplemental Digital Content 1, https://links.lww.com/INF/E805). Several virulence markers have recently been described in some species of Paenibacillus.6 The reported pediatric cases of Paenibacillus spp. infections to date including our case were in infants born prematurely who developed severe CNS infections leading to poor outcomes. Consistent with a prior report,4P. dendritiformis in our case was found to be susceptible to penicillin.FIGURE 2.: A: A full phylogenetic tree of 244 Paenibacillus species. B: A subtree of (A) shows that the unknown sample most resembles P. dendritiformis. Only branches with a phylogenetic score greater than 70% are shown." @default.
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• W4295693276 date "2022-10-03" @default.
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• W4295693276 title "Paenibacillus dendritiformis Meningitis, Brain Abscesses and Cystic Encephalomalacia in an Infant: Case Presentation and Review of the Literature" @default.
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• W4295693276 doi "https://doi.org/10.1097/inf.0000000000003684" @default.
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