2983                MENINGITIS DUE TO ESCHERICHIA COLI

The patient was a 24 year old man who had an appendicectomy 4 weeks before his admission.  After the operation he began to lose weight and complained of increasingly severe headaches and pain in his neck and shoulders.  On examination the significant signs were drowsiness and neck rigidity.  A white blood count showed moderate leukocytosis (13,500).  Lumbar puncture revealed a turbid C.S.F., containing numerous gram-negative, lactose fermenting bacilli.  These gave the fermentation reactions of E.coli.  Treatment was not available (the year was 1929) and the patient died 2 weeks after admission.

The specimen consists of the entire brain.  The convolutions are flattened and many sulci contain purulent material lying along the congested vessels.  The base of the brain is covered with excess exudate, particularly in the subarachnoid space overlying the pons, interpeduncular fossa and gyri recti.  The left cerebellar tonsil projects downwards along the medulla oblongata probably responsible for the patient’s death.

Comment:  E.coli meningitis in the adult is rare.  Small infants have a somewhat greater incidence because E.coli is more pathogenic at that age group (compare E.coli enteritis).  In any large series, at any age group, meningitis due to enterobacteria accounts for only a minute proportion of all cases of meningitis.  In this case, there was probably a period of bacteraemia after the appendicectomy, the meningitis representing a metastatic infection.