A case of pneumoccocal meningitis with complication diagnosed with polymerase chain reaction

Abstract

Culture results that allow diagnosis and treatment of bacterial meningitis are at the earliest 24-48 hours. Therefore, cell count in CSF, biochemical properties of CSF and examination of CSF by Gram staining are of great importance for early diagnosis together with clinical findings. Since the meningitis is an emergency in terms of infection, especially in cases where the empirical treatment is started early without CSF and blood sample collection, or if patients have already received antibiotic treatment, the probability of detection of the agent in culture is reduced or disappeared. In such cases, diagnosis can be made by gram staining of CSF, investigation of bacterial antigens in CSF, and investigation of bacterial DNA by polymerase chain reaction. In this study, a 46-year-old female patient was presented and the literature was reviewed. In the case, ceftriaxone treatment was started without a CSF sample due to a preliminary diagnosis of meningitis. Therefore, no agent was detected in culture, but Streptococcus pneumoniae (S.pneumoniae) was found to be positive in CSF by multiplex PCR. Althoug apropriate antimicrobial treatment, the superior sagittal sinus and diffuse cerebral thrombus in bilateral transverses developed as a complication of pneumococcal meningitis

Keywords

• Meningitis
• bacterial agents
• S.pneumoniae
• multiplex-PCR

Polimeraz zincir reaksiyonu ile tanısı konulan ve komplikasyonla seyreden bir pnömokok menenjiti olgusu

Abstract

Bakteriyel menenjitlerin erken tanısı ve tedavisinde kültür sonuçları en erken 24-48 saatte çıktığından ötürü, klinik bulgularla birlikte BOS’da hücre sayımı, BOS’un biyokimyasal özellikleri ve BOS’un Gram boyama ile incelenmesi büyük önem taşımaktadır. Özellikle menenjitlerin infeksiyon acili olması nedeniyle kültür için BOS ve kan örneği alınmadan ampirik tedavinin erken başlandığı veya hastaların önceden antibiyotik tedavisi aldığı durumlarda kültürde etkenin saptanma olasılığı azalır veya ortadan kalkar. Bu gibi durumlarda BOS’un Gram boyaması, BOS’da bakteri antijenlerinin araştırılması yanı sıra son yıllarda polieraz zincir reaksiyonu ile de bakteri DNA’sı araştırılarak da tanıya gidilebilmektedir. Burada, menenjit ön tanısıyla BOS örneği alınmadan seftriakson tedavisi başlanan bu nedenle kültürde etkenin saptanmadığı, ancak; multipleks PZR yöntemiyle BOS’da Streptococcus pneumoniae (S.pneumoniae) pozitif saptanan 46 yaşında bir kadın hasta sunularak literatür gözden geçirildi. Olguda uygun antimikrobiyal tedaviye rağmen, pnömokok menenjiti komplikasyonu olarak superior sagittal sinüs ve bilateral transverslerde yaygın serebral trombüs gelişti.

Keywords

• Menenjit
• bakteriyel etkenler
• S.pneumoniae
• multipleks-PZR

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