Case of Fatal Meningoencephalitis Following Accidental Near Drowning
Vykuntaraju K Gowda, Chetan Kerur, Alkarani Patil, Sanjay K Shivappa
Keywords :
Fungal meningoencephalitis, Near drowning, Traumatic brain injury
Citation Information :
Gowda VK, Kerur C, Patil A, Shivappa SK. Case of Fatal Meningoencephalitis Following Accidental Near Drowning. Pediatr Inf Dis 2023; 5 (2):56-57.
Introduction: Central Nervous System infections are the most common cause of mortality and morbidity in developing countries. We are reporting a rare case of neuroinfection following drowning.
Case description: Fourteen-year-old boy with a history of near drowning was initially treated for respiratory distress requiring mechanical ventilation and a right femur fracture. He was all right for 15 days at home later he developed a fever and weakness in his left lower and upper limbs. MRI of the brain showed a mass lesion with vasogenic edema requiring decompression craniotomy. Brain biopsy during decompressive craniectomy showed granulomatous inflammation composed of sheets of histiocytes, lymphocytes, and many foreign body giant cells. PAS and GMS stains highlight fungal hyphae/pseudohyphae.
Conclusion: Fungal meningoencephalitis should be considered in case of neuro infection following near drowning in addition to bacterial infections and should be treated urgently.
Sahu RN, Kumar R, Mahapatra AK. Central nervous system infection in the pediatric population. J Pediatr Neurosci 2009;4(1):20–24. DOI: 10.4103/1817-1745.49102
McCarthy M, Rosengart A, Schuetz AN, et al. Mold infections of the central nervous system. N Engl J Med 2014;371(2):150–160. DOI: 10.1056/NEJMra1216008
Carter JH, Lenahan JL, Ishak GE, et al. Medical management of invasive fungal infections of the central nervous system in pediatric cancer patients. Pediatr Blood Cancer 2015;62(6):1095–1098. DOI: 10.1002/pbc.25331
Mathur M, Johnson CE, Sze G. Fungal infections of the central nervous system. Neuroimaging Clin N Am 2012;22(4):609–632. DOI: 10.1016/j.nic.2012.04.004
Mohan S, Jain KK, Arabi M, et al. Imaging of meningitis and ventriculitis. Neuroimaging Clin N Am 2012;22(4):557–583. DOI: 10.1016/j.nic.2012.04.003
Walsh TJ, Anaissie EJ, Denning DW, et al. Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis 2008;46(3):327–360. DOI: 10.1086/525258
Madigan T, Fatemi Y, Theel ES, et al. Central nervous system blastomycosis in children: a case report and review of the literature. Pediatr Infect Dis J 2017;36(7):679–684. DOI: 10.1097/INF.0000000000001523
Salvatore CM, Chen TK, Toussi SS, et al. (1→3)—β-D-glucan in cerebrospinal fluid as a biomarker for Candida and Aspergillus infections of the central nervous system in pediatric patients. J Pediatric Infect Dis Soc 2016;5(3):277–286. DOI: 10.1093/jpids/piv014
Baytan B, Evim MS, Güler S, et al. Acute central nervous system complications in pediatric acute lymphoblastic leukemia. Pediatr Neurol 2015;53(4):312–318. DOI: 10.1016/j.pediatrneurol.2015.03.006
Levy ER, McCarty JM, Shane AL, et al. Treatment of pediatric refractory coccidioidomycosis with combination voriconazole and caspofungin: a retrospective case series. Clin Infect Dis 2013;56(11):1573–1578. DOI: 10.1093/cid/cit113
Brick KE, Drolet BA, Lyon VB, et al. Cutaneous and disseminated blastomycosis: a pediatric case series. Pediatr Dermatol 2013;30(1): 23–28. DOI: 10.1111/j.1525-1470.2012.01799.x