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Extensive subclinical sinusitis leading to Moraxella osloensis meningitis

Extensive subclinical sinusitis leading to Moraxella osloensis meningitis
Extensive subclinical sinusitis leading to Moraxella osloensis meningitis

We report a case of a 31 year old male with extensive subclinical sinusitis leading to erosion in the cribriform plate and subsequent meningitis caused by the organism Moraxella osloensis. The patient presented to the emergency department with rapid onset confusion, neck stiffness and headache. Inflammatory markers, renal and liver function, and a chest radiograph were all normal. CT Head showed extensive polyp disease in the paranasal sinuses with expansion of the left frontal sinus and CT Sinuses revealed an area of low attenuation in the cribriform plate consistent with bony erosion. MRI Head showed thick loculated sinus inflammation. Lumbar puncture yielded CSF with a high white cell count of predominantly mononuclear cells, no visible organisms and an elevated protein. CSF microscopy, culture and viral PCR were not diagnostic, and so the CSF was sent for 16S rDNA PCR screening, which identified the rDNA of Moraxella osloensis. Moraxella osloensis is a rare cause of bacterial meningitis, with only a few reported cases. This case illustrates that sinusitis, while a common condition, when severe can predispose to intracranial infection with atypical and low virulence organisms such as Moraxella species, which do not commonly cause invasive CNS disease. This case represents the first case of Moraxella osloensis meningitis reported from the United Kingdom.

2214-2509
39-42
Fox-Lewis, A
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Coltart, G
b6b066c1-7d33-45a4-a5bb-c0872a39cf36
Rice, S
c5474388-af7f-4a5a-901e-d338000e6a67
Sen, R
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Gourtsoyannis, Y
bc903d71-cd2e-41dc-ae2d-f35ce5a8faa0
Hyare, H
c90c1f5d-ba58-452f-8d34-ef97760a517c
Gupta, R K
de1cf9ad-f52f-450b-b03b-d8bf1f44b91a
Fox-Lewis, A
452fa783-92ed-4b41-a2bf-7b7fa42c010d
Coltart, G
b6b066c1-7d33-45a4-a5bb-c0872a39cf36
Rice, S
c5474388-af7f-4a5a-901e-d338000e6a67
Sen, R
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Gourtsoyannis, Y
bc903d71-cd2e-41dc-ae2d-f35ce5a8faa0
Hyare, H
c90c1f5d-ba58-452f-8d34-ef97760a517c
Gupta, R K
de1cf9ad-f52f-450b-b03b-d8bf1f44b91a

Fox-Lewis, A, Coltart, G, Rice, S, Sen, R, Gourtsoyannis, Y, Hyare, H and Gupta, R K (2016) Extensive subclinical sinusitis leading to Moraxella osloensis meningitis. IDCases, 6, 39-42. (doi:10.1016/j.idcr.2016.08.007).

Record type: Article

Abstract

We report a case of a 31 year old male with extensive subclinical sinusitis leading to erosion in the cribriform plate and subsequent meningitis caused by the organism Moraxella osloensis. The patient presented to the emergency department with rapid onset confusion, neck stiffness and headache. Inflammatory markers, renal and liver function, and a chest radiograph were all normal. CT Head showed extensive polyp disease in the paranasal sinuses with expansion of the left frontal sinus and CT Sinuses revealed an area of low attenuation in the cribriform plate consistent with bony erosion. MRI Head showed thick loculated sinus inflammation. Lumbar puncture yielded CSF with a high white cell count of predominantly mononuclear cells, no visible organisms and an elevated protein. CSF microscopy, culture and viral PCR were not diagnostic, and so the CSF was sent for 16S rDNA PCR screening, which identified the rDNA of Moraxella osloensis. Moraxella osloensis is a rare cause of bacterial meningitis, with only a few reported cases. This case illustrates that sinusitis, while a common condition, when severe can predispose to intracranial infection with atypical and low virulence organisms such as Moraxella species, which do not commonly cause invasive CNS disease. This case represents the first case of Moraxella osloensis meningitis reported from the United Kingdom.

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Published date: 21 August 2016

Identifiers

Local EPrints ID: 455414
URI: http://eprints.soton.ac.uk/id/eprint/455414
ISSN: 2214-2509
PURE UUID: 003cf352-bd2c-425c-9a4c-db193150a466
ORCID for G Coltart: ORCID iD orcid.org/0000-0001-7648-8741

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Date deposited: 21 Mar 2022 17:42
Last modified: 13 Aug 2022 02:08

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Contributors

Author: A Fox-Lewis
Author: G Coltart ORCID iD
Author: S Rice
Author: R Sen
Author: Y Gourtsoyannis
Author: H Hyare
Author: R K Gupta

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