[Streptococcus salivarius meningitis after oral trauma by a skewer: a case report]

Although Streptococcus salivarius is one of the normal flora in the oral cavity and gastrointestinal tract, the agent may cause bacteremia, meningitis, endocarditis and sinusitis under certain circumstances. We report a 3-year-old female with meningitis after oral trauma by a skewer due to penicillin resistant S. salivarius. The girl injured her throat accidentally with a skewer. Four hours later, she became febrile and came to our emergency room. Plain CT scan was normal, and cefalexin was prescribed. The next day, she had fever, lethargy, meningeal signs, and her cerebrospinal fluid (CSF) showed neutrophilic pleocytosis. The blood culture was negative, but the CSF culture was positive for S. salivarius. The minimal inhibitory concentrations (MIC) for panipenem, penicillin G, ampicillin, cefotaxime, ceftriaxone, vancomycin were 0.125 microgram/ml, 2 micrograms/ml, 2 micrograms/ml, 0.5 microgram/ml, 0.5 microgram/ml, 0.5 microgram/ml, respectively. Intravenous administration of panipenem betamiprom (PAPM/BP) 2 g/day for 7 days and 8 courses of dexamethasone 0.15 mg/kg/dose were effective, and she has had no apparent sequelae except for a slight abnormality in her electroencephalogram. Traumatic meningitis is often caused by S. pneumoniae, but may be also caused by the normal flora pathogens including S. salivarius. In addition, our case suggests that not only S. pneumoniae but also S. salivarius can be penicillin resistant. Taking the drug resistance into consideration, we have to be careful in choosing antibiotics for treating such patients.