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

Year 2021, Volume: 2 Issue: 2, 58 - 61, 05.06.2021

Gülşah Gelişigüzel , Salih Cesur , Kader Arslan , Şerife Altun Demircan , Ülkü Siyah , Sami Kınıklı

https://doi.org/10.47582/jompac.823515

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

Supporting Institution

-

Project Number

-

Thanks

-

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

Project Number

-

References

• Akkaya O, Güvenç Hİ, Güzelant A, et al. Menenjit etkenlerinin real-time PCR yöntemiyle araştırılması. Türk Mikrobiyol Cem Derg 2017; 47: 131-7.
• Parlak M. Akut bakteriyel menenjitler. Toplumdan edinilmiş enfeksiyonlara pratik yaklaşımlar Sempozyum Dizisi, İ.Ü. Cerrahpaşa Tıp Fakültesi yayınları 2008; 61: 151-64.
• Jarrin I, Sellier P, Lopes A, et al. Etiologies and management of aseptic meningitis in patients admitted to an internal medicine department. Medicine (Baltimore) 2016; 95: e2372
• Albuquerque RC, Moreno ACR, Dos Santos SR, Ragazzi SLB, Martinez MB. Multiplex-PCR for diagnosis of bacterial meningitis. Braz J Microbiol 2019; 50: 435-43.
• Jing-Zi P, Zheng-Xin H, Wei-Jun C, Yong-Qiang J. Detection of bacterial meningitis pathogens by PCR-Mass spectrometry in cerebrospinal fluid. Clin Lab 2018; 64: 1013-9.
• Nour M, Alaidarous A. Clinical usefulness and accuracy of polymerase chain reaction in the detection of bacterial meningitis agents in pediatric cerebrospinal fluid. Curr Res Transl Med 2018; 66: 15-8.
• Seth R, Murthy PSR, Sistla S, Subramanian M, Tamilarasu K. Rapid and accurate diagnosis of acute pyogenic meningitis due to Streptococcus pneumoniae, Haemophilus influenzae Type b and Neisseria meningitidis Using A Multiplex PCR Assay. J Clin Diagn Res 2017; 11: FC01-4.
• Alqayoudhi A, Nielsen M, O'Sullivan N, et al. Clinical utility of polymerase chain reaction testing for Streptococcus pneumoniae in pediatric cerebrospinal fluid samples: a diagnostic accuracy study of more than 2000 samples from 2004 to 2015. Pediatr Infect Dis J 2017; 36: 833-6.
• Khater WS, Elabd SH. Identification of common bacterial pathogens causing meningitis in culture-negative cerebrospinal fluid samples using real-time polymerase chain reaction. Int J Microbiol 2016; 2016: 4197187.
• Kastenbauer S, Pfister HW. Pneumococcal meningitis in adults: spectrum of complications and prognostic factors in a series of 87 cases. Brain. 2003; 126: 1015-25.
• Ilgar T, Özel Ö, Hatipoğlu ÇA, et al. Kafa kaidesi kırığına bağlı pnömokok menenjiti sekeli olarak gelişen serebral enfarktüs olgusu. Turk J Clin Lab 2017; 8: 217-20.
• Hénaff F, Levy C, Cohen R, et al. Risk factors in children older than 5 years with Pneumococcal meningitis: data from a national network. Pediatr Infect Dis J 2017; 36: 457-61.
• Vergouwen MD, Schut ES, Troost D, van de Beek D. Diffuse cerebral intravascular coagulation and cerebral infarction in pneumococcal meningitis. Neurocrit Care 2010; 13: 217-27.
• DiNubile MJ, Boom WH, Southwick FS. Septic cortical thrombophlebitis. J Infect Dis 1990; 161: 1216-20.