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Meningitis due to penicillin-resistant Streptococcus pneumoniae in patients with chronic graft-versus-host disease
D D'Antonio1, P Di Bartolomeo, A Iacone
1Divisione di Ematologia-Laboratorio di Microbiologia Clinica Ospedale, Pescara, Italy.
Abstract:
Two episodes of meningitis due to penicillin-resistant Streptococcus pneumoniae occurring in two patients with chronic graft-versus-host disease (GVHD) are reported. Both patients were treated with ceftazidime. The first patient died, unresponsive to therapy. The second patient showed clinical improvement, reverting to her baseline mental status. This report draws attention to the fact that in chronic GVHD patients: (1) bacterial prophylaxis does not ensure protection against encapsulated bacteria; (2) rapid microbiological investigation is recommended with any upper respiratory tract infections.
Insights
Chronic graft-versus-host disease (GVHD) patients face meningitis risks from resistant bacteria. Prophylaxis may fail, necessitating prompt infection investigation in these vulnerable individuals.
Area of Science:
- Infectious Diseases
- Hematology
- Immunology
Background:
- Chronic graft-versus-host disease (GVHD) is a serious complication of allogeneic stem cell transplantation.
- Patients with chronic GVHD are immunocompromised and susceptible to opportunistic infections.
- Encapsulated bacteria, such as Streptococcus pneumoniae, pose a significant threat to these patients.
Purpose of the Study:
- To report cases of meningitis caused by penicillin-resistant Streptococcus pneumoniae in patients with chronic GVHD.
- To highlight the limitations of bacterial prophylaxis in preventing infections in this population.
- To emphasize the importance of early microbiological diagnosis for respiratory infections in chronic GVHD patients.
Main Methods:
- Case report of two patients with chronic GVHD who developed meningitis.
- Review of treatment strategies and patient outcomes.
- Analysis of the effectiveness of bacterial prophylaxis.
Main Results:
- Two patients with chronic GVHD developed meningitis due to penicillin-resistant Streptococcus pneumoniae.
- One patient, treated with ceftazidime, died due to the infection.
- The second patient, also treated with ceftazidime, showed clinical improvement.
Conclusions:
- Bacterial prophylaxis does not guarantee protection against encapsulated bacteria in chronic GVHD patients.
- Prompt microbiological investigation is crucial for any upper respiratory tract infections in patients with chronic GVHD.
- These findings underscore the need for vigilant monitoring and aggressive management of infections in this high-risk group.