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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2022; 41(03): e245-e248
DOI: 10.1055/s-0040-1716563
Review Article

Neonate Brain Abscess by Cronobacter spp: A Powdered Infant Formula's Opportunistic Pathogen

Abscesso cerebral neonatal por Cronobacter spp: Um patógeno oportunista de fórmula láctea infantil
Bárbara Albuquerque Morais
1   Department of Pediatric Neurosurgery, Universidade de São Paulo, São Paulo, SP, Brazil
,
Djalma Felipe Da Silva Menendez 
2   Department of Neurosurgery, Universidade de São Paulo, São Paulo, SP, Brazil
,
Iuri Santana Neville Ribeiro 
2   Department of Neurosurgery, Universidade de São Paulo, São Paulo, SP, Brazil
,
Cibeli Ribeiro Borsetto
3   Department of Pediatrics, Hospital e Maternidade Victoria, São Paulo, SP, Brazil
,
Fernando De Sousa Nascimento
3   Department of Pediatrics, Hospital e Maternidade Victoria, São Paulo, SP, Brazil
,
Manoel Jacobsen Teixeira
2   Department of Neurosurgery, Universidade de São Paulo, São Paulo, SP, Brazil
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Abstract

Cronobacter spp is an opportunistic pathogen that can cause severe neonatal infections, including septicemia, meningitis, and necrotizing enterocolitis. Over 90% of these infections outbreaks are associated with the increased consumption of powdered infant formula (PIF). We report the case of a male neonate born at term with adequate weight for gestational age, fed by breast milk and PIF. He was admitted to the ICU at 22 days old due to fever, irritability, impaired consciousness, and food intolerance. Investigation revealed an extensive abscess in the right frontoparietal region, that was surgically drained. The culture of the purulent material showed the growth of Cronobacter spp. Guided antibiotic was kept for 21 days. The patient presented a good clinical outcome, without neurological deficits. The microbiological powdered formula contamination by Enterobacter sakazakii (Cronobacter spp) can lead to a higher risk of severe infections in infants. Children may present sepsis, sensory alteration, and refractory seizures. An early brain image should be considered for symptomatic infants. The mortality rate ranges from 40 to 80%, and 74% of survivors have an adverse neurological outcome. From 1997–2013, there were reports of 6 outbreaks of E. sakazakii disease in Brazil. According to the World Health Organization (WHO), this disease is undernotified, and active foodborne surveillance systems are less than ideal. To better address this problem, in some countries, the notification is mandatory, and the adoption of stricter sanitary measures by regulatory agencies are proposed.

Resumo

O Cronobacter spp é um patógeno oportunista que pode causar infecções neonatais graves, incluindo septicemia, meningite e enterocolite necrosante. Mais de 90% dessas infecções estão associadas ao aumento do consumo de fórmula infantil em pó (FIP). Relatamos o caso de um recém-nascido do sexo masculino, nascido a termo, com peso adequado para a idade gestacional, alimentado com leite materno e FIP. Ele foi internado na UTI com 22 dias de idade devido a febre, irritabilidade, comprometimento da consciência e intolerância alimentar. A investigação revelou abscesso extenso na região frontoparietal direita, que foi drenada cirurgicamente. A cultura do material purulento mostrou o crescimento de Cronobacter spp. Antibiótico guiado foi mantido por 21 dias. O paciente apresentou bom resultado clínico, sem déficits neurológicos. A contaminação microbiológica da fórmula em pó pela Enterobacter sakazakii (Cronobacter spp) pode levar a um risco aumentado de infecções graves neonatais. As crianças podem apresentar sepse, alterações sensoriais e crise convulsiva refratária. Uma imagem cerebral precoce deve ser considerada nestes pacientes. A taxa de mortalidade varia de 40 a 80%, e 74% dos sobreviventes têm um quadro neurológico sequelar. Entre 1997 e 2013, houve relatos de 6 surtos de E. sakazakii no Brasil. De acordo com a Organização Mundial de Saúde (OMS), esta doença está subnotificada e os sistemas de vigilância alimentar são insuficientes. Para resolver esse problema, em alguns países, a notificação é obrigatória e a adoção de medidas sanitárias mais rigorosas é exigida pelas agências reguladoras.

Keywords

enterobacter sakazakii - cronobacter spp. - brain abscess - powdered infant formula - neonatal sepsis

Palavras-chave

enterobacter sakazakii - cronobacter spp. - abcesso cerebral - fórmula láctea infantil em pó - sepse neonatal


Publication History

Received: 20 December 2019

Accepted: 07 July 2020

Article published online:
23 September 2022

© 2022. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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