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Successful treatment of meningitis caused by highly-penicillin-resistant Streptococcus mitis in a leukemic child

Tang-Her Jaing1, Cheng-Hsun Chiu, Iou-Jih Hung

  • 1Department of Pediatrics, Chang Gung Children's Hospital, Taipei.

Chang Gung Medical Journal
|May 23, 2002
PubMed

Insights

Viridans streptococci, particularly Streptococcus mitis, can cause severe infections in neutropenic cancer patients. This case highlights successful treatment of S. mitis meningitis in a child with leukemia, even with antibiotic resistance.

Area of Science:

  • Infectious Diseases
  • Oncology
  • Microbiology

Background:

  • Viridans streptococci are increasingly implicated in infections among neutropenic cancer patients.
  • Streptococcus mitis exhibits high resistance to beta-lactam antibiotics within this group.
  • Bacterial meningitis without cerebrospinal fluid (CSF) pleocytosis is a rare and diagnostically challenging presentation.

Observation:

  • A 6-year-old boy with leukemia and neutropenia developed sepsis and meningitis.
  • The causative agent was identified as Streptococcus mitis with high-level resistance to penicillin and cephalosporins.
  • The patient presented with meningeal signs despite the absence of CSF pleocytosis.

Findings:

  • Successful treatment was achieved using a combination of vancomycin, ceftriaxone, and granulocyte-colony-stimulating factor.
  • The patient, who received trimethoprim-sulfamethoxazole prophylaxis, experienced a long-term survival.
  • This case underscores the importance of considering bacterial meningitis in neutropenic patients with meningeal signs, irrespective of CSF findings.

Implications:

  • Highlights the potential for antibiotic-resistant S. mitis in immunocompromised hosts.
  • Emphasizes the need for vigilance in diagnosing meningitis in neutropenic patients, even with atypical CSF profiles.
  • Demonstrates a viable therapeutic strategy involving combination therapy and supportive care for challenging S. mitis infections.

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