Community-Acquired Escherichia coli Sepsis and Meningitis Complicated by Bilateral Subdural Effusion in a Previously Healthy Three-Month-Old Infant: A Case Report

Escherichi coli sepsis and meningitis complicated by bilateral subdural effusion

Abstract

Background: Escherichia coli is an important cause of bacterial meningitis during the neonatal period but is an uncommon cause of community-acquired meningitis in previously healthy infants beyond the neonatal period. Subdural effusion is a recognized complication of bacterial meningitis in infancy and may mimic subdural empyema, creating an important diagnostic and therapeutic challenge.

Case Description: Reported here is a case of a 3-month-old infant  with a bilateral subdural effusion culture positive for  E. coli. The child was managed successfully with 6 weeks of meropenem.

Conclusion: Community-acquired E. coli meningitis should be considered in young infants with severe bacterial meningitis even beyond the neonatal period, including those without recognized predisposing conditions. In infants with persistent fever, seizures, irritability, or delayed clinical recovery, neuroimaging is important for identifying intracranial complications and distinguishing subdural effusion from empyema. In the absence of imaging or clinical features suggesting subdural infection or significant mass effect, conservative management with close clinical and radiological follow-up may be appropriate.