Microbiology Case Study: A 10 Year Old Girl with New Onset Fever

A 10 year old girl presented to the ED with several month history of worsening CNS symptoms, including gait instability, left-sided weakness, nausea, vomiting, several witnessed seizure events and loss of consciousness. MRI revealed right frontal mass measuring 7.0 cm in greatest dimension with midline shift. The patient underwent a right-sided craniotomy with tumor resection and was closely followed in the PICU. On post-op day 3, the patient appeared pale and lethargic with a temperature of 39.9 C. Blood cultures were collected and the patient empirically started on ceftriaxone and vancomycin for meningitis coverage. Due to worsening fever and altered mental status, a lumbar puncture was performed with the following results:

  • Opening pressure: 10.5 cm
  • Appearance: slightly cloudy
  • Cells: 91% PMN
  • Gram negative rods were identified on gram smear

 

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Gram stain shows gram negative rods. Photo credit: Dr. Gary Kaiser.

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Photo credit: University Medical Center of Rotterdam, Dept. of Microbiology and Infectious Disease

Discussion

Pseudomonas stutzeri is an aerobic gram negative bacilli (GNB) with a single polar flagellum that is both catalase and oxidase positive. Several defining features help distinguish P. stutzeri from other Pseudomonas species, including its nutritional versatility (utilizes starch, maltose, and ethylene glycol), its inability to produce fluorescent pigment and its “coral-like” appearance on growth medium.  There are no known virulence factors for P. stutzeri. Hospital distribution rates of P. stutzeri are approximately 1-2% of Pseudomonas spp. Nosocomial infection via medical devices or solutions is the most common route of infection. P. stutzeri isolates are sensitive to beta lactam antibiotics—meropenem is commonly used.

 

-Christina Litsakos is a Pathology Student Fellow at University of Vermont Medical Center.

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-Christi Wojewoda, MD, is the Director of Clinical Microbiology at the University of Vermont Medical Center and an Assistant Professor at the University of Vermont.

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