A case of community-acquired pneumococcal meningitis following acute sinusitis and unsuccessful former antimicrobial therapy

Abstract

Rapid diagnosis and treatment are critical for patient recovery in bacterial meningitis. Delayed initiation of antibiotic therapy is associated with increased in-hospital mortality and an unfavorable outcome at discharge. We report a 31-year-old female patient presenting with a history of acute sinusitis and cefuroxime medication for 7 days. On the 7th day, the patient was admitted to the emergency department with nausea, vomiting, confusion, headache, tendency to sleep. On physical examination, the patient presented with unresponsiveness and weak neck stiffness as a sign of meningeal irritation. Cerebrospinal fluid analysis revealed 13,446 leukocytes per mm3 with 95% neutrophils and 5% lymphocytes. CSF biochemical analysis indicated low CSF glucose (<1 mg/dL glucose), elevated CSF protein (476 mg/dL total protein) and >2000,00 mg/L albumin. CSF RT-qPCR was positive for Streptococcus pneumoniae. The patient was immediately administered ceftriaxone and vancomycin, and recovered without any neurological sequelae. This study highlights the importance of patient follow-up, accurate prognosis and rapid laboratory testing in patients with failed sinusitis treatment.

Keywords

• Streptococcus pneumoniae
• meningitis
• sinusitis
• treatment failure
• rapid molecular diagnosis

Akut sinüzit ve başarısız antimikrobiyal tedavi sonrası gelişen toplum kökenli pnömokokal menenjit olgusu

Abstract

Bakteriyel menenjitte hızlı tanı ve tedavi hastanın iyileşmesi için kritik öneme sahiptir. Antibiyotik 60 tedavisine geç başlanması, hastane içi mortalitede artış ve taburcuda olumsuz bir sonuç ile 61 ilişkilidir. Bu yazıda akut sinüzit öyküsü olan ve 7 gün sefuroksim tedavisi almış 31 yaşında kadın 62 bir olgu sunuldu. Hasta 7. gününde bulantı, kusma, bilinç bulanıklığı, baş ağrısı, uykuya eğilim 63 şikayetleri ile acil servise başvurdu. Fiziki muayenede, meningeal iritasyon belirtisi olarak zayıf 64 boyun sertliği gozlendi. Beyin omurilik sıvısı (BOS) analizinde, %95 nötrofil ve %5 lenfosit olmak 65 üzere 13,446/mm3 lökosit görüldü. BOS biyokimyasal analizde, düşük BOS glikozu (<1 mg/dL 66 glikoz), yüksek BOS proteini (476 mg/dL toplam protein) ve >2000,00 mg/L albümin saptandı. BOS RT-qPCR Streptococcus pneumoniae açısından pozitif olarak sonuçlandı. Seftriakson ve vankomisin tedavisi başlandı ve hasta herhangi bir nörolojik komplikasyon olmadan iyileşti. Bu çalışma tedavi edilemeyen akut sinüzit sonrası gelişen toplum kökenli pnömokokal menenjit vakasını rapor etmekte ve bu vakalarda hasta takibinin, doğru prognozun ve hızlı laboratuvar testlerinin önemini vurgulamaktadır.

Keywords

• Streptococcus pneumoniae
• menenjit
• sinüzit
• başarısız tedavi
• hızlı moleküler tanı

References

1. Mook-Kanamori BB, Geldhoff M, van der Poll T, et al. Pathogenesis and pathophysiology of pneumococcal meningitis. Clin Microbiol Rev. 2011;24:557–591.
2. van de Beek D, Brouwer M, Hasbun R, et al. Community-acquired bacterial meningitis. Nat. Rev. Dis. Primers. 2016;2:1–20.
3. Bijlsma MW, Brouwer MC, Kasanmoentalib ES, et al. Community-acquired bacterial meningitis in adults in the Netherlands, 2006–14: A prospective cohort study. Lancet Infect. Dis. 2016;16:339–347.
4. van Kassel MN, van Haeringen KJ, Brouwer MC, et al. Community-acquired group B streptococcal meningitis in adults. J. Infect. 2020;80:255–260.
5. Lundbo LF, Benfield T. Risk factors for community-acquired bacterial meningitis. Infect. Dis. 2017;49:433–444.
6. Lucas MJ, Brouwer MC, van de Beek D. Neurological sequelae of bacterial meningitis. J. Infect. 2016;73:18–27.
7. Auburtin M, Porcher R, Bruneel F, et al. Pneumococcal meningitis in the intensive care unit: prognostic factors of clinical outcome in a series of 80 cases. AJRCCM. 2002;165:713–717.
8. Østergaard, C, Konradsen HB, Samuelsson S. Clinical presentation and prognostic factors of Streptococcus pneumoniae meningitis according to the focus of infection. BMC Infect. Dis. 2005:5: 1–11.

9. Montassier, E, Trewick D, Batard E, et al. Streptococcus pneumoniae meningitis in an adult with normal cerebrospinal fluid. CMAJ. 2011;183:1618–1620.
10. Fuglsang-Damgaard D, Pedersen G, Schønheyder HC. Positive blood cultures and diagnosis of bacterial meningitis in cases with negative culture of cerebrospinal fluid. Scand. J. Infect. Dis. 2008;40:229–233.
11. Lesnakova A, Holeckova K, Kolenova A, et al. Bacterial meningitis after sinusitis and otitis media: ear, nose, throat infections are still the commonest risk factors for the community acquired meningitis. Neuro Endocrinol. Lett. 2007;28:14–15.