Ralstonia Pickettii Meningitis in a Child with Hydrocephalus

Introduction

Ralstonia pickettii (RP), a Gram-negative aerobic rod with low virulence, colonises the human oral cavity and upper respiratory tract. RP mainly cause bloodstream infections in immunocompromised individuals and chronic airway infection in patients suffering from cystic fibrosis [9] [12]. Nosocomial outbreaks of RP systemic infections are reported to be associated with contaminated fluids used for patient care and laboratory use, and contaminations of indwelling devices are well described [3] [4] [6] [8] [9] [12] [14]. Infections of ventriculoperitoneal shunts are rare but serious infections. A diverse spectrum of pathogens is involved. Krcméry et al. reviewed more than 100 episodes of nosocomial meningitis with more than 40% being associated with a ventriculoperitoneal shunt [5]. In their study population, two thirds of pathogens were Gram-positive cocci with coagulase-negative staphylococci outnumbering all other species. However, they found some cases in which non-fermentative Gram-negative bacilli were involved. The mortality rate in this study was 15%. Palabiyikoglu et al. reviewed 51 cases of nosocomial meningitis and >50% of cases were associated with shunts [10]. Shunt patients were predominantly children. Non-fermentative Gram-negative bacilli accounted for 22% of isolated pathogens; however, during the study period these organisms became the leading pathogens with Acinetobacter spp. becoming a particular problem. Infections of a ventriculoperitoneal shunt with RP thus far only have been reported in adults [15] [16]. This is the first report of such an infection in a paediatric patient.

References

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