PMC7303839_01
(A) Selected cases of Ewingella americana infection. Examples of clinical presentation after E. americana infection with the associated antibiogram. To note, the prevalence of immunocompromised patients and the presence of only three previously reported pediatric cases (case n.1, 2, and 3). TMP/SMX, Trimethoprim/sulfamethoxazole; CKD, Chronic kidney disease; COPD, Chronic obstructive pulmonary disease. (B) Clinical and laboratory findings in a newborn with E. americana meningitis.
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F1
The CBC at admission revealed WBC 22,900/uL (differential as noted in Figure 1B) and platelets of 100,000/uL. CBC repeated a few hours later showed normal platelets of 150,000/uL, WBC 21,000/uL (Figure 1B). Initial cerebrospinal fluid (CSF) profile, drawn on day of life (DOL) 1, was unremarkable with 4 WBC/uL, 84 RBC/uL, protein of 46 mg/dl and glucose of 47 mg/dl (Figure 1B). While speciation was pending, a repeat LP performed on DOL 6 showed increased WBC (71/muL), RBC (200/muL), normal protein (49 mg/dl), and glucose (41 mg/dl) (Figure 1B). LP done prior to discharge was within normal limits with a negative CSF culture (Figure 1B).
Antimicrobial susceptibility results of E. americana in our patient.
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F2
Based on the sensitivity profile (Figure 2) and a better CSF penetration, the infectious disease team recommended discontinuing ampicillin and treating with ceftazidime for 21 days from the first negative CSF culture.