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

Year 2023, Volume: 7 Issue: 1, 75 - 80, 30.04.2023

Montaser M.y Amro , Buket Baddal , Kaya Süer , Nurhak Demir

https://doi.org/10.34084/bshr.1278367

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

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