case_images: PMC10420072_01
case_images: (A) The infant presents with convulsions and corneal regurgitation. (B) Cerebrospinal fluid sample on the day of admission. (C) Drained cerebrospinal fluid sample. (D) Electroencephalogram of the infant on the 10th day of admission.
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case_images: PMC10420072_01_fpubh-11-1174536-g0001.jpg
case_images: F1
case_images: On admission, the infant had a body temperature of 39.7  C, angular arches (Figure 1A). Cerebrospinal fluid (CSF) examination revealed a yellowish, cloudy color (Figure 1B), and a smear showed Gram-negative bacteria infection. The drainage fluid turned light red with flocculent material on January 21st (Figure 1C), but the fever was repeated, the limbs were tonic and shaking. From the ninth day of admission, the blood pressure dropped repeatedly with blood oxygenation and decreased heart rhythm, dobutamine epinephrine was given with continuous pumping and volume expansion, and the video electroencephalogram showed no significant electroencephalogram activity (Figure 1D).
case_images: (A) On 2022.01.19th, head CT shows no obvious abnormal density lesions in the brain parenchyma, enlargement of the ventricular with lateral ventricular dilatation as the main feature, no displacement of midline structures and no widening of the sulcus pool. (B) On 2022.01.24th, head CT scan showed severe cerebral edema and significant shrinkage of the ventricular compared with before. (C, D) On 2022.01.26th, MRI scan of the head showed changes in the left ventricle after puncture drainage. Severe cerebral edema suggested the presence of ventricular and subarachnoid hemorrhage.
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case_images: PMC10420072_01_fpubh-11-1174536-g0002.jpg
case_images: F2
case_images: A CT head examination was performed (Figure 2A), which showed no significant abnormal density lesions in the patient's brain parenchyma, thus intracranial hemorrhage and transient lesions were ruled out and a preliminary diagnosis of hydrocephalus was made. A CT scan of the head on day 6 (Figure 2B) and an MRI scan of the head on day 8 (Figures 2C, D) showed that the ventricular was significantly smaller, and the lateral ventricular drainage tube was removed on day 8.
case_images: (A) Schematic diagram of the patient's inflammatory factors, pathogen detection results and medication administration over time. (B) On day 4 of admission, the cerebrospinal fluid mNGS showed 19291 specific sequences with 97% coverage. (C, D) Light and electron microscopic observations of the pure culture of the pathogen. (E) The genomic -based homology analysis of the pathogen based on mNGS sequences. (F) The MLST homology analysis of the pathogen based on mNGS sequences.
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case_images: PMC10420072_01_fpubh-11-1174536-g0003.jpg
case_images: F3
case_images: He was immediately treated with meropenem combined with cefsevox, mannitol to lower cranial pressure, and nutritional support (Figure 3A). On day 3 of admission, blood culture detected E. coli (Figure 3A). The next day, E. coli was also detected in CSF culture and mNGS (Hangzhou Matridx Biotechnology Co.,Ltd.; Figure 3B). Subsequently, exploration of pure cultures of the pathogen further confirmed that the Gram-negative bacterium exhibited podocytes in electron microscopic observations (Figures 3C, D). This result was also confirmed by genomic homology analysis of the sequence obtained by sequencing in the mNGS results (Figures 3E, F).