Case ReportCitrobacter koseri meningitis: Another freediving risk?
Section snippets
Case description
A 63 year old man presented with an episode of severe, bifrontal headache 4 days after returning from a 2-week holiday in the British Virgin Islands, where he was freediving in open water. This involved diving without the assistance of breathing apparatus to depths of 10–12 m up to twice a day. During his holiday, he had been well, but developed a mild left earache just prior to returning to the UK. This increased in severity upon his return, and coincided with a noticeable reduction in his
Discussion
The genus Citrobacter belongs to the family of Enterobacteriae and comprises 11 species of facultative anaerobic Gram negative bacilli. In the environment Citrobacter are commonly found in water and soil.1 They also colonise the gastrointestinal tract and therefore can cause urinary tract, respiratory, intra-abdominal, wound and central nervous system (CNS) infections.1, 2 Citrobacter meningitis is most commonly seen in neonates and children.3 A single case report in a previously well
Conclusion
We present a case of an immunocompetent adult who acquired meningitis caused by an environmental organism, C. koseri, which is likely to have gained access to the CNS following barotrauma as a result of freediving. The case not only illustrates the importance of a detailed clinical history to elucidate the aetiology of otherwise spontaneous cases of meningitis, but also highlights another previously unreported potential hazard of this recreational activity.
Consent
The patient described gave written consent that his case could be used as the basis for this manuscript.
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