Tohoku J. Exp. Med., 2012, 227(3)

Escherichia coli Pneumonia in Combination with Fungal Sinusitis and Meningitis in a Tsunami Survivor after the Great East Japan Earthquake

RYOTARO IGUSA,¹ SODAI NARUMI,² KOJI MURAKAMI,² YUKO KITAWAKI,³ TORU TAMII,³ MASAHIRO KATO,⁴ MINESHIGE SATO,⁴ MASAHIRO TSUBOI⁵ and KOZO OTA³

¹Department of Respiratory Medicine, Osaki Citizen Hospital, Osaki, Japan
²Department of Respiratory Medicine, Tohoku University Hospital, Sendai, Japan
³Department of Internal Medicine, Osaki Citizen Hospital, Osaki, Japan
⁴Department of Neurology, Osaki Citizen Hospital, Osaki, Japan
⁵Department of Radiology, Osaki Citizen Hospital, Osaki, Japan

Individuals who survive near drowning often suffer from complicated infections, including multi-organ and polymicrobial events. This pattern may be especially pronounced among patients exposed to infectious agents during catastrophic events like that of the Great East Japan Earthquake and the associated tsunami disaster. We report here on a patient who presented with Escherichia coli (E. coli) pneumonia in combination with fungal sinusitis and meningitis. A 73-year-old woman survived the tsunami that engulfed the Sanriku coast. By the time of hospital admission, the patient exhibited high fever, severe cough, and sputum production. Chest X-ray and CT scan showed consolidation in the left upper lobe. Administration of an antibacterial agent improved this pneumonia. However, the patient's consciousness was increasingly impaired. Brain CT showed the low-density lesions and partial high-density spot in the sinus, which suggests the fungal infection. MRI showed the inflammation in the sinus spread into the central nerve system. The examination of the cerebrospinal fluid showed the low glucose level, high mononuclear cell count, and highβ-D glucan level, the findings of which supported the diagnosis of fungal meningitis. Although the patient improved temporarily in response to combination treatment with anti-fungal agents, no further improvement was seen. In conclusion, this patient, who suffered from infections of pneumonia, sinusitis, and meningitis, presented a quite rare clinical progress. We propose that fungal infection should be taken into consideration in individuals who suffered near drowning, a profile expected to be frequent among tsunami survivors.

keywords —— extended-spectrum β-lactamase-producing Escherichia coli; fungal meningitis; tsunami-related aspiration pneumonia; tsunami-related sinusitis; tsunami victims

© 2012 Tohoku University Medical Press

===============================

Tohoku J. Exp. Med., 2012, 227, 179-184

Correspondence:Ryotaro Igusa, M.D., Ph.D.,Department of Respiratory Medicine, Osaki Citizen Hospital, 2-3-10 Furukawa Senjyujimati, Oskai, Miyagi 989-6183, Japan.

e-mail: ryoigusa@h-osaki.jp