citrobacter freundii,,,can anyone help?

October 23, 2004

Hi, I was hoping someone could assist in understanding IMPLICATIONS AND

CONNECTIONS OF a +4 citrobacter freundii, (dysbiotic flora) in a stool sample

from a 17 year old with ASD

i have seen some indirect association with hg poisoning...but i also want

to find any and all info on this,,,,thanks so much...suzanne messina REAACH

October 23, 2004

C. freundii is a nasty critter, whose talents include causing brain

and cerebellar abscesses. Recently, a CDSA showing C. freundii listed

antibiotics and non-prescription supplements effective against C.

freundii. Chances are that gi C. freundii won't cause meningitis in a

specific individual, but " not likely " seems less reassuring in a child

with increased intestinal permeability and suboptimal nutritional status

ths suboptimal immunity and suboptimal detoxification.

1: Microb Pathog. 2001 Jan;30(1):19-28.

Bacterial invasion and transcytosis in transfected human brain microvascular

endothelial cells.

Stins MF, Badger J, Sik Kim K.

Division of Infectious Diseases, Children's Hospital Los Angeles, Los

Angeles,

CA, USA.

Most cases of neonatal bacterial meningitis develop as a result of a

hematogenous spread, but it is not clear how circulating bacteria cross the

blood-brain barrier. Attempts to answer these questions have been

hampered by

the lack of a reliable model of the human blood-brain barrier. Human brain

microvascular endothelial cells (HBMEC) were isolated and transfected with a

pBR322 based plasmid containing simian virus 40 large T antigen

(SV40-LT). The

transfected HBMEC exhibited similar brain endothelial cell

characteristics as

the primary HBMEC, i.e. gamma glutamyl transpeptidase and a high

transendothelial electrical resistance. Escherischia coli and

Citrobacter spp,

two important Gram-negative bacilli causing neonatal meningitis, were

found to

transcytose across primary and transfected HBMEC, without affecting the

integrity of the monolayer. In addition, E. coli and C. freundii invaded

transfected HBMEC as shown previously with primary HBMEC. We conclude

that E.

coli and C. freundii are able to invade and transcytose HBMEC and these

bacterial-HBMEC interactions are similar between primary and transfected

HBMEC.

Therefore, our transfected HBMEC should be useful for studying

pathogenesis of

PMID: 11162182 [PubMed - indexed for MEDLINE]

2: Changgeng Yi Xue Za Zhi. 1999 Dec;22(4):649-53.

Adult Citrobacter freundii meningitis: case report.

Chuang YC, Chang WN, Lu CH.

Department of Neurology, Chang Gung Memorial Hospital, Kaohsiung,

Taiwan, R.O.C.

Citrobacter is a distinct group of Gram-negative bacilli belonging to the

Enterobacteriaceae family. Central nervous system (CNS) infections due to

Citrobacter are uncommon, though they occur more frequently in neonates and

young children. In adults, Citrobacter meningitis is extremely unusual

with only

6 cases reported in the literature before 1998. This rare CNS infection

has been

seen in patients with head trauma, following neurosurgical procedures,

and in

those who are immunocompromised. Of the patients in the 6 reported

cases, only

one developed multi-antibiotic resistant Citrobacter CNS infection.

Adding to

this small number of reported cases, we report an adult case of

post-neurosurgical meningitis and subdural empyema caused by

multi-antibiotic

resistant Citrobacter freundii and also review the literature related to

this

infection. Antimicrobial therapy with imipenem and third-generation

cephalosporins failed to result in cerebrospinal fluid sterilization in our

patient. Because of the use of broad-spectrum antibiotics, multi-antibiotic

resistant Citrobacter species have developed in this nosocomial CNS

infection

and now present a therapeutic challenge. Therefore, further clinical

studies are

needed to determine updated therapeutic modalities for treating this

life-threatening infection.

Publication Types:

Case Reports

Review

Review of Reported Cases

PMID: 10695216 [PubMed - indexed for MEDLINE]

3: Pediatr Infect Dis J. 1999 Oct;18(10):889-92.

Citrobacter urinary tract infections in children.

Gill MA, Schutze GE.

Department of Pediatrics and Pathology, The University of Arkansas for

Medical

Sciences, Arkansas Children's Hospital, Little Rock 72202-3591, USA.

BACKGROUND: Citrobacter species have been described as the etiologic

agents in

cases of bacteremia, meningitis, diarrhea and brain abscess, but little

is known

of their role as a cause of urinary tract infections in children. The

purpose of

this study was to define the role of Citrobacter species in pediatric

urinary

tract infections. METHODS: The project consisted of a retrospective

chart review

of microbiologic and medical records of patients younger than 18 years

of age

with urine cultures positive for Citrobacter species during a 3-year period.

RESULTS: Thirty-four patients with 37 infections were included in the

review.

The average patient age was 6.9 years (range, 1 month to 18 years) and

71% were

female. Fifty-six percent of the patients had urinary tract/renal

anomalies or

neurologic impairment and 26% represented nosocomial infections.

Thirty-seven

percent of patients were asymptomatic at the time of diagnosis, whereas 63%

complained of at least one of the following findings: gastrointestinal

symptoms;

dysuria; fever; incontinence; penile/vaginal discharge; frequency; flank

pain;

and hematuria. Twenty-six of the isolates were Citrobacter freundii and

11 were

Citrobacter koseri. Blood cultures were obtained in 9 patients and all were

negative for Citrobacter isolates. CONCLUSIONS: Although it is uncommon

Citrobacter can cause urinary tract infections in the pediatric population,

which occur more frequently in children with underlying medical

conditions. It

appears that treatment similar to that of other gram-negative enteric

organisms

is the most prudent approach to these children until more information can be

gathered.

PMID: 10530585 [PubMed - indexed for MEDLINE]

4: Infect Immun. 1999 Aug;67(8):4208-15.

Citrobacter freundii invades and replicates in human brain microvascular

endothelial cells.

Badger JL, Stins MF, Kim KS.

Division of Infectious Diseases, Childrens Hospital Los Angeles, Los

Angeles,

California 90027, USA.

Neonatal bacterial meningitis remains a disease with unacceptable rates of

morbidity and mortality despite the availability of effective antimicrobial

therapy. Citrobacter spp. cause neonatal meningitis but are unique in their

frequent association with brain abscess formation. The pathogenesis of

Citrobacter spp. causing meningitis and brain abscess is not well

characterized;

however, as with other meningitis-causing bacteria (e.g., Escherichia

coli K1

and group B streptococci), penetration of the blood-brain barrier must

occur. In

an effort to understand the pathogenesis of Citrobacter spp. causing

meningitis,

we have used the in vitro blood-brain barrier model of human brain

microvascular

endothelial cells (HBMEC) to study the interaction between C. freundii and

HBMEC. In this study, we show that C. freundii is capable of invading and

trancytosing HBMEC in vitro. Invasion of HBMEC by C. freundii was

determined to

be dependent on microfilaments, microtubules, endosome acidification, and de

novo protein synthesis. Immunofluorescence microscopy studies revealed that

microtubules aggregated after HBMEC came in contact with C. freundii;

furthermore, the microtubule aggregation was time dependent and seen with C.

freundii but not with noninvasive E. coli HB101 and meningitic E. coli

K1. Also

in contrast to other meningitis-causing bacteria, C. freundii is able to

replicate within HBMEC. This is the first demonstration of a

meningitis-causing

bacterium capable of intracellular replication within BMEC. The important

determinants of the pathogenesis of C. freundii causing meningitis and brain

abscess may relate to invasion of and intracellular replication in HBMEC.

PMID: 10417193 [PubMed - indexed for MEDLINE]

5: Clin Neurol Neurosurg. 1994 Feb;96(1):52-7.

Citrobacter meningitis in adults.

Tang LM, Chen ST, Lui TN.

Department of Neurology, Chang Gung Memorial Hospital and Chang Gung Medical

College, Taipei, Taiwan.

Citrobacter meningitis is an uncommon infection of neonates and young

children.

It is rarely seen in adults. We describe a 46-year-old man with a mixed

bacterial meningitis caused by C. diversus and Klebsiella oxytoca and a

64-year-old woman with C. freundii meningitis. Review of the

English-language

literature revealed only 2 adult patients with C. diversus meningitis and

another 2, with C. freundii meningitis. The ages of these 6 aforementioned

patients ranged from 31 to 84 years. Multiple facial fractures,

neurosurgical

procedures, alcoholism and diabetes mellitus were predisposing

conditions. Among

the 5 patients whose outcome was known, antibiotic therapy was

successful in 4

but failed in 1. This study emphasizes that almost any of the gram-negative

bacilli can cause serious infection of the central nervous system in

adults in

the proper setting.

Publication Types:

Case Reports

Review

Review, Tutorial

PMID: 8187383 [PubMed - indexed for MEDLINE]

6: DICP. 1991 Jan;25(1):27-9.

Successful treatment of neonatal Citrobacter freundii meningitis with

ceftriaxone.

Rae CE, Fazio A, les JP.

School of Pharmacy, Northeast Louisiana University, Monroe 71209.

Citrobacter meningitis is an uncommon enteric gram-negative infection that

afflicts neonates and young children. Approximately 30 percent of children

treated or untreated die from the infection. We report a case of C. freundii

meningitis that was resistant to ampicillin and was successfully treated

with

ceftriaxone, a third-generation cephalosporin. A 13-day-old, full-term

baby was

admitted to the hospital with a one-day history of fever up to 38.8

degrees C.

On admission the infant had a temperature of 39.2 degrees C, pulse of 140

beats/min, and a respiratory rate of 32 breaths/min. Except for a slightly

bulging fontanelle, the rest of the physical examination was within normal

limits. Complete blood count revealed a white blood cell (WBC) count of

12.5 x

10(9)/L, with 0.66 polymorphonuclear cells, 0.10 bands, 0.18

lymphocytes, and

0.06 monocytes. A stat lumbar puncture showed 10 WBCs per high-power

field with

gram-negative rods. Empiric therapy with ampicillin 225 mg q12h and

gentamicin

11 mg q8h was started. Both antibiotics were discontinued after culture and

sensitivity results were positive for C. freundii in the blood and

spinal fluid.

The patient was successfully treated with nine days of ceftriaxone 250

mg q12h.

Publication Types:

Case Reports

PMID: 2008783 [PubMed - indexed for MEDLINE]

7: Pediatr Neurosurg. 1991-92;17(1):23-4.

Neonatal meningitis and bilateral cerebellar abscesses due to Citrobacter

freundii.

Joaquin A, Khan S, Russel N, al Fayez N.

King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia.

We report bilateral cerebellar abscesses in a neonate with Citrobacter

freundii

meningitis. The mortality and morbidity of Citrobacter abscess is high.

Rapidly

developing drug resistance may play a role as illustrated by our case.

Publication Types:

Case Reports

PMID: 1811708 [PubMed - indexed for MEDLINE]

8: South Med J. 1979 Dec;72(12):1598-9.

Citrobacter freundii meningitis in an adult.

Scheld WM, Tyson GW.

We have described the first case of an adult patient with Citrobacter

freundii

meningitis, which was successfully treated without administration of

intrathecal

aminoglycoside.

Publication Types:

Case Reports

PMID: 515772 [PubMed - indexed for MEDLINE]

9: West J Med. 1977 Nov;127(5):418-22.

Cerebral abscesses complicating neonatal Citrobacter freundii meningitis.

Kaplan AM, Itabashi HH, Yoshimori R, Weil ML.

Publication Types:

Case Reports

PMID: 919545 [PubMed - indexed for MEDLINE]

Suzanne Messina wrote:

>

> Hi, I was hoping someone could assist in understanding

> IMPLICATIONS AND CONNECTIONS OF a +4 citrobacter freundii,

> (dysbiotic flora) in a stool sample from a 17 year old with ASD

>

> i have seen some indirect connection to nercury

> poisoning...but alos, I am hoping for any information on this

> ....thanks so much Suzanne Messina

>

October 23, 2004

Citrobacter freundii is NOT a pathogen, dixit my doctor.

My ASD son had a 4+ but that was his first stool test and we started

him on the anti-yeast & tons of probiotics regiment and it was gone

at the following stool test.

>

> Hi, I was hoping someone could assist in understanding

IMPLICATIONS AND CONNECTIONS OF a +4 citrobacter freundii,

(dysbiotic flora) in a stool sample from a 17 year old with ASD

>

> i have seen some indirect association with hg poisoning...but

i also want to find any and all info on this,,,,thanks so

much...suzanne messina REAACH

>

October 24, 2004

Hi ,

Are all citrobacters dangerous like this one?

What about citrobacter amalonaticus? My NT 2 yearold has an imbalance

of 3+ with this one.

Thanks,

Jen

>

> >

> > Hi, I was hoping someone could assist in understanding

> > IMPLICATIONS AND CONNECTIONS OF a +4 citrobacter freundii,

> > (dysbiotic flora) in a stool sample from a 17 year old with

ASD

> >

> > i have seen some indirect connection to nercury

> > poisoning...but alos, I am hoping for any information on this

> > ....thanks so much Suzanne Messina

> >

>

> >

>

October 25, 2004

My daughter had a score of 3+ also here. Heard it's not good stuff to have

around. Along with it we saw the prescription and non-prescription drugs that

were sensitive to it. (Not sure if all would have the same sensitivities...)

Although we're in this leaky gut situation due to heavy antibiotics, a few

months after getting this report my daughter was faced with again needing an

antibiotic for her bronchitis. I was ill over the thought, but none of the

homeopath treatments work, and bronchitis is nasty stuff. I figured if I had to

give her an antibiotic, maybe I could give her one that could address both the

bronchitis and the citrobacter. Luckily there was one on the list. I can't say

for sure if it was that which did it or other natural attempts, but did test it

and it was gone after. However I believe it was because I have heard this is

hard stuff to get rid. Unfortunately it's a case of trying to figure out what

is most important to focus on, and/or will others come back. From what I've

seen, others have actually gone the prescription route here first, killed it

off, and then refocused on the gut/yeast issue. Of course I supplemented