Otogenic meningoencephalitis caused by Streptococcus pneumoniae

Abstract

Tsetsa Georgieva Doichinova, Galya Ivanova Gancheva, Stefan Ivanov Mirchev, Nachko Iliev Totsev Meningitis/ meningoencephalitis due to Streptococcus pneumoniae are with severe course and high mortality rate. A case of severe meningoencephalitis by S.pneumoniae secondary to chronic bilateral otitis and mastoiditis is presented here. A 37-year-old male patient was admitted with fever, excitation, somnolence and meningeal irritation. Investiga­tion of cerebrospinal fluid (CSF) revealed increased protein level (11.3 g/L), leucocytes count 59,790/μL (93% neutro­phils), extremely decreased glucose level (0.1 mmol/L). S.pneumoniae was confirmed by latex test and culture of CSF. Otitis media and mastoiditis were found bilaterally by computerized tomography. Bilateral cortical mastoidectomy was performed together with antibacterial treatment by consequently ceftazidime and cefepime and corticosteroids were administered. He experienced progressive improvement and was discharged with normal laboratory parameters and without sequels after 17 days hospital treatment. In conclusion, both surgical and conservative treatments are crucial for outcome of meningitis/ meningoencephalitis by S.pneumoniae secondary to chronic mastoiditis.

Keywords

• Streptococcus pneumoniae

Otogenic meningoencephalitis caused by Streptococcus pneumoniae

Öz

Streptococcus pneumoniae’nın sebep olduğu menenjit/meningoensefalitler ağır bir seyrederler ve yüksek mortalite gösterirler. Burada kronik bilateral otitis media ve mastoidite seconder olarak gelişen ciddi seyirli bir S. pneumoniae olgusu sunuldu. Otuz yedi yaşında erkek hasta ateş, eksitasyon, somnolans ve menings irritasyon bulguları ile başvurdu. Beyin omurilik sıvısı (BOS) incelemesinde artmış protein seviyesi (11,3 g/L), lökosit sayısı µL’de 59790 (%93’ü nötrofil) ve çok düşük düzeyde glukoz düzeyi (0,1 mmol/L) bulundu. S. pneumoniae’nın etken olduğu BOS’tan yapılan lateks testi ve kültürle doğrulandı. Bilgisayarlı tomografi ile bilateral otitis media ve mastoidit olduğu gösterildi. Seftazidim ve devamında sefepim ve şeklinde antibakteriyel tedavi, destek tedavisi ve kortikosteroid uygulaması yanında bilateral kortikal mastoidektomi yapıldı. Hasta hızlı bir iyileşme gösterdi ve hastanede 17 gün süren bir tedaviden sonra normal klinik ve laboratuvar bulgularla taburcu edildi. Sonuç olarak hem cerrahi hem de konservatif tedavi kronik mastoidite sekonder olan ve S. pneumoniae’nın etken olduğu menenjit/ meningoensefalitlerde akıbet için hayati önem taşırlar

Anahtar Kelimeler

• Streptococcus pneumonia, menenjit, meningoensefalit, mastoidit

Kaynakça

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