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Pneumococcal endocarditis and disseminated infection
S R Heard1, J Pickney, D S Tunstall-Pedoe
1Department of Medical Microbiology, St Bartholomew's Hospital, West Smithfield, London.
Abstract:
A 61 year old woman presented with back pain and clinical signs of meningitis. Pleocytosis in the cerebrospinal fluid was found, but although Streptococcus pneumoniae was cultured from her blood it failed to grow from the cerebrospinal fluid. An echocardiogram detected vegetations on the mitral valve and a lesion at S1/S2 was demonstrated on a bone scan. Treatment for one month with benzylpenicillin (1200 mg four hourly) was successful for both the cardiac and neurological components of her infection, but her back pain only resolved after treatment was changed to clindamycin. The clinical presentation and metastatic spread of the S pneumoniae infection is much more commonly seen in the context of S aureus endocarditis. It is rare for the pneumococcus to be associated with endocarditis and when it is mortality is usually high. This case shows the metastatic potential of the organism and the requirement for appropriate antibiotics with regard not only to the sensitivity of the organism, but also for the site of infection.
Insights
This case highlights a rare Streptococcus pneumoniae endocarditis infection. Appropriate antibiotic selection is crucial for treating both the infection and its metastatic complications.
Area of Science:
- Infectious Diseases
- Cardiology
- Neurology
Background:
- Streptococcus pneumoniae is a common cause of pneumonia and meningitis, but rarely associated with endocarditis.
- Endocarditis, particularly with Staphylococcus aureus, is known for metastatic complications.
Observation:
- A 61-year-old woman presented with meningitis symptoms and back pain, with positive blood cultures for S. pneumoniae.
- Echocardiogram revealed mitral valve vegetations, and a bone scan showed a lesion at S1/S2, indicating metastatic spread.
- Initial benzylpenicillin treatment improved cardiac and neurological symptoms, but back pain persisted.
Findings:
- Complete resolution of back pain occurred only after switching to clindamycin, suggesting specific antibiotic penetration or activity was required.
- This case underscores the metastatic potential of S. pneumoniae, even in the rare context of endocarditis.
Implications:
- Highlights the importance of considering antibiotic choice based on infection site and organism sensitivity, not just in vitro susceptibility.
- Emphasizes the need for prompt diagnosis and tailored treatment for rare but severe presentations of S. pneumoniae endocarditis to improve patient outcomes.