We report an unusual case of E. coli meningitis in an elderly woman who presented to the emergency room with a chief complaint of intractable low back pain.
A 67 year old woman presented to the emergency room for a chief complaint of intractable low back pain. After admission, the patient developed delirium. Blood cultures were drawn. Patient underwent a lumbar puncture which revealed purulent cerebrospinal fluid. Results of the cerebrospinal fluid and blood cultures revealed pan-sensitive E. coli.
In the geriatric population, delayed presentation of meningitis can occur for various reasons. With the older adult population, existing co-morbidities and decline in immunologic function can mask symptoms. Clinicians caring for the elderly population need to have a high index of suspicion in the setting of subtle symptoms when it comes to diagnosing acute bacterial meningitis.
Key Words: bacteremia, meningitis, geriatric, E. Coli, clinical, cerebrospinal, cultures, delirium
Conflict(s) of Interest
References with DOI
1. Domingo P, Pomar V, Benito ND, Coll P. The spectrum of acute bacterial meningitis in elderly patients. BMC Infectious Diseases. 2013;13(1). https://doi.org/10.1186/1471-2334-13-108
2. Bacterial Meningitis [Internet]. Centers for Disease Control and Prevention. Centers for Disease Control and Prevention; 2016 [cited 2016Oct16]. Available from: http://www.cdc.gov/meningitis/bacterial.html
3. Choi C. Bacterial Meningitis in Aging Adults. Clinical Infectious Diseases. 2001;33(8):1380–5. https://doi.org/10.1086/322688
4. Thigpen MC, Whitney CG, Messonnier NE, Zell ER, Lynfield R, Hadler JL, et al. Bacterial meningitis in the United States, 1998–2007. New England Journal of Medicine. 2011;364(21):2016–25. https://doi.org/10.1056/nejmoa1005384
5. Yoshino Y, Seo K, Koga I, Kitazawa T, Ota Y. A case of community-onset bacterial meningitis due to extended-spectrum beta-lactamase producing escherichia coli. J Med Cases Journal of Medical Cases. 2013;4(7):511-514. https://doi.org/10.4021/jmc1362e
6. Khan F, Abukhattab M, Anand D. Nosocomial escherichia coli meningitis in adults: report of four cases and literature review. Journal of Neurosciences in Rural Practice. 2013;4(3):349. https://doi.org/10.4103/0976-3147.118800
7. Beek DVD, Gans JD, Tunkel AR, Wijdicks EF. Community-acquired bacterial meningitis in adults. New England Journal of Medicine. 2006;354(1):44–53. https://doi.org/10.1056/nejmra052116
8. Boleij A, Schaeps RMJ, Tjalsma H. Association between streptococcus bovis and colon cancer. Journal of Clinical Microbiology. 2009;47(2):516. https://doi.org/10.1128/jcm.01755-08
Lauffer, Andrea M.; Shorman, Mahmoud; and McComas, Carl
"An unusual case of Escherichia coli meningitis and bacteremia in an elderly woman presenting with intractable low back pain,"
Marshall Journal of Medicine:
4, Article 10.
Available at: http://mds.marshall.edu/mjm/vol2/iss4/10