Penicillin-resistant pneumococcal meningitis following a head trauma in a chronic alcoholic patient

Abstract

Chronic alcohol use may suppress central nervous system infections or interfere with clinical conditions such as alcohol withdrawal syndrome. Sensitivity to infectious agents is increased in alcoholic patients due to the impaired immunological response to microorganisms, malnutrition and vitamin deficiency. The most common meningitis in these patients is Streptococcus pneumoniae. Penicillin resistance in pneumococci, is a major source of concern in recent years all over the world and in Turkey. In the treatment of pneumococcal infections, which are highly resistant to penicillin, a combination of third-generation cephalosporins (ceftriaxone, cefotaxime) and vancomycin is applied along with dexamethasone therapy. If there is a delay in the diagnosis and treatment of pneumococcal meningitis, the mortality rate is high. In this article, we present a 40-year-old male patient with chronic alcohol use history who was diagnosed with penicillin-resistant Streptococcus pneumoniae meningitis with delayed diagnosis and mortality which was developed after a head trauma. 

Keywords

• Alcoholic head trauma,meningitis,penicillin-resistant pneumococcus

Kronik alkol kullanımı olan bir hastada kafa travmasını takiben gelişen penisiline dirençli pnömokok menenjiti

Abstract

Kronik alkol kullanan bireylerde santral sinir sistemi infeksiyonu bulguları baskılanabilir veya alkol yoksunluk sendromu gibi klinik durumlarla karışabilir. Alkolik hastalarda mikroorganizmalara karşı immun yanıtın etkilenmesi, malnutrisyon ve vitamin eksikliği gibi nedenlerle infeksiyon etkenlerine karşı duyarlılık artar. Bu hastalarda en sık görülen menenjit etkeni Streptococcus pneumoniae’dır. Pnömokoklarda penisilin direnci son yıllarda tüm dünyada ve Türkiye’de önemli bir endişe kaynağıdır. Penisiline yüksek düzey dirençli pnömokok infeksiyonlarının tedavisinde üçüncü kuşak sefalosporinler (seftriakson, sefotaksim) ve vankomisin kombinasyonu ile birlikte deksametazon tedavisi tercih edilir. Pnömokokal menenjitte tanı ve tedavide gecikme olması durumunda mortalite oranı yüksektir. Bu yazıda, kronik alkol kullanımı öyküsü olan 40 yaşında bir erkek hastada kafa travmasını takiben gelişen, geç tanı konulan ve mortal seyreden penisiline dirençli Streptococcus pneumoniae menenjiti olgusu sunuldu.  

Keywords

• Alkolik hasta,kafa travması,menenjit,penisiline dirençli pnömokok

References

1. 1. Edward N. Janoff and Daniel M. Musher. Streptococcus pneumoniae. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases, Updated Edition, 2015; 2310-2327.e5.
2. 2. Van Veen KE, Brouwer MC, van der Ende A, van de Beek D. Bacterial meningitis in alcoholic patients: A population-based prospective study. J Infect 2017; 74 : 352-57.
3. 3. Kim AC, Epstein ME, Goyal PG, Doan TL. Infections in Alcoholic Liver Disease. Clin Liver Dis 2012; 16: 783–803.
4. 4. Leelarasamee A, Dhiraputra C, Hunnangkul S. Severe pneumococcal infection at a Thai hospital. Int J Infect Dis 1999; 3: 147-52.
5. 5. Weisfelt M, de Gans J, van der Ende A, van de Beek D. Community-acquired bacterial meningitis in alcoholic patients. PLoS One 2010; 5: 9102.
6. 6. Verghese VP, Veeraraghavan B, Jayaraman R, Varghese R, Neeravi A, Jayaraman Y, Thomas K, Mehendale SM. Increasing incidence of penicillin- and cefotaxime-resistant Streptococcus pneumoniae causing meningitis in India: Time for revision of treatment guidelines? Indian J Med Microbiol 2017; 35: 228-36.
7. 7. Cherazard R, Epstein M, Doan TL, Salim T, Bharti S, Smith MA. Antimicrobial Resistant Streptococcus pneumoniae: Prevalence, Mechanisms, and Clinical Implications. Am J Ther 2017 ; 24: 361-69.
8. 8. Muley VA, Ghadage DP, Yadav GE, Bhore AV. Study of Invasive Pneumococcal Infection in Adults with Reference to Penicillin Resistance. J Lab Physicians 2017 ; 9: 31-35.

9. 9. Erdem H, Elaldi N, Öztoprak N et al. Mortality indicators in pneumococcal meningitis: therapeutic implications. Int J Infect Dis 2014 ; 19: 13-19.
10. 10. Bijlsma M, Matthijs C Brouwer, E et al. Community-acquired bacterial meningitis in adults in the Netherlands, 2006–14: a prospective cohort study. Lancet Infect Dis 2016; 16: 339–47.
11. 11. Hameed N, Tunkel AR. Treatment of drug-resistant pneumococcal meningitis. Curr Infect Dis Rep 2010 ; 12: 274-81.
12. 12. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; 20thInformational Supplement, 2010, M100-S20. CLSI, Wayne, PA.
13. 13. Taşova Y, Saltoğlu N, Dündar İH. Çok ilaca dirençli pnömokokal menenjit: bir olgu sunumu.Flora Dergisi 1998; 3: 134-39.