P3C205: Brain Abscess Secondary to Edwardsiella Tarda Infection in a Neonate

Introduction: Infection of humans with Edwardsiella Tarda bacteria is a rare occurrence. Edwardsiella tarda is a gram-negative bacillus usually found in aquatic environments and water-borne animals. Human affectation may result in non-clinical disease, however, clinical disease manifests most frequently in the gastrointestinal tract. Extra-intestinal disease can be seen in the skin, respiratory tract, gastrointestinal tract, central nervous system, and genitourinary system. Brain abscesses overall are rare in the neonatal population, and even more rarely seen is brain abscess from Edwardsiella Tarda infection. We outline a case of an 8-day-old female who was diagnosed with brain abscess secondary to Edwardsiella Tarda.

Case Description: An 8-day old term female presented to the hospital with 1 day of fever, Tmax 101.3 F, increased fussiness, decreased feeding, diarrhea, and emesis. Early CSF studies were consistent with bacterial meningitis, and she was given cefepime, ampicillin, and acyclovir at meningitic doses then admitted. Despite continued antibiotics, there was minimal improvement. Rare Edwardsiella tarda bacteria was found on CSF culture. Head imaging was done to investigate possible abscess formation. Imaging revealed suspected necrotic/liquefied aspect of the left frontal region measuring 2.5x1.9x1.4 cm with the entire lesion measuring 5.0x4.9x3.6 cm. Patient was managed by infectious disease, neurosurgery, and neurology teams. She had serial imaging to follow brain lesion, and received antibiotic therapy, with coverage narrowed per culture sensitivities and infectious disease specialist recommendations. Antibiotic therapy was IV ampicillin for 38 days total, with the last dose completed 4 weeks after the first negative ventricular CSF culture. Her clinical course was complicated by post-infectious hydrocephalus, focal epilepsy without impairment of consciousness, unspecified cerebral infarction, and right frontotemporal brain abscess, managed with antiepileptic medication, EVD and eventual VP shunt placement. Patient showed clinical improvement with medical and surgical interventions, and adjunct physical and occupational therapies. Long term follow-up of patient revealed no developmental delay or adverse neurological sequelae.

Discussion: Although Edwardsiella tarda infection is associated with aquatic environments, it is unclear how our patient was infected with this organism consistent with majority of other cases. One case report described a good clinical outcome on antibiotic therapy alone, however, this was reported as meningitis without complication of brain abscess/cerebritis. Another report described multiple abscesses in a neonate in Japan and attributed the patient’s good clinical outcome to the combination of antibiotic therapy, EVD placement, and VP shunt insertion as was ultimately performed for our patient.

Conclusion: To our knowledge, this is the first report of Edwardsiella tarda brain abscess occurring in a neonate within the United States with good clinical outcomes following antibiotic therapy and surgical intervention. This case emphasizes the importance of obtaining imaging in cases where Edwardsiella tarda is isolated in CSF culture due to this organism’s propensity to cause localized and systemic abscesses.