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Incidental intraoperative diagnosis of Mycobacterium abscessus meningeal infection: a case report and review of the literature

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Abstract

Purpose

Mycobacterium abscessus, and rapidly growing mycobacteria in general, are rare but increasing causes of central nervous system (CNS) infections. The aim of this study is to highlight the importance of considering these microorganism in the differential diagnosis of CNS infections, obtaining a prompt diagnosis, and improving clinical outcomes.

Methods

Case report and literature review.

Results

We report a case of meningeal infection in a patient who underwent decompressive craniectomy after a craniofacial trauma. The diagnosis was made analyzing a sample obtained during a second operation of cranioplasty. A regimen of amikacin, clarithromycin, and imipenem/cilastatin was started. In the following days, the patient experienced a variety of side effects. So, first clarithromycin was replaced with linezolid, then amikacin was stopped and cefoxitin added to the therapy and at the end all the antibiotics were withdrawn. The patient was discharged in good conditions and a clinical interdisciplinary follow-up was started. After 12 months, the patient is still doing well. After a literature analysis, 15 cases of M. abscessus CNS infections were identified. Various modes of acquisition, underlying disease and therapeutic schemes were evident.

Conclusions

Considering the results of the literature analysis and the increasing incidence of M. abscessus, all specialists involved in the management of CNS infection should be aware of the importance of atypical microorganisms in differential diagnosis.

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Acknowledgements

We thank Dr. Angela Bohnen for her contribution to the English language editing.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Infectious Diseases, Catholic University of Rome, Rome, Italy

    Francesca Giovannenze, Giancarlo Scoppettuolo, Fernando Damiano & Federico Pallavicini

  2. Department of Neurosurgery, Catholic University of Rome, Largo A. Gemelli 8, 00168, Rome, Italy

    Vito Stifano, Alessandro Rapisarda, Cosimo Sturdà & Angelo Pompucci

  3. Department of Microbiology, Catholic University of Rome, Rome, Italy

    Giovanni Delogu & Ivana Palucci

Authors
  1. Francesca Giovannenze
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  2. Vito Stifano
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  3. Giancarlo Scoppettuolo
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  4. Fernando Damiano
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  5. Federico Pallavicini
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  6. Giovanni Delogu
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  7. Ivana Palucci
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  8. Alessandro Rapisarda
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  9. Cosimo Sturdà
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  10. Angelo Pompucci
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Corresponding author

Correspondence to Vito Stifano.

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An approval by an ethics committee was not applicable.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Giovannenze, F., Stifano, V., Scoppettuolo, G. et al. Incidental intraoperative diagnosis of Mycobacterium abscessus meningeal infection: a case report and review of the literature. Infection 46, 591–597 (2018). https://doi.org/10.1007/s15010-018-1141-5

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  • DOI: https://doi.org/10.1007/s15010-018-1141-5

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