[A case of vancomycin resistant Leuconostoc meningitis]

Although Leuconostoc species are rarely pathogenic for humans, they may sometimes give rise to serious infections. In this report, a case of meningitis caused by vancomycin resistant Leuconostoc spp. was reported. Fifty-seven years old female patient was admitted to the hospital with the complaints of headache and sudden onset of unconsciousness and hospitalized in the neurosurgery department because of subarachnoidal hemorrhage. Patient was followed up with dexamethasone treatment and daily lumbar puncture without any surgical intervention. The findings of hemorrhage were receded in the cerebrospinal fluid (CSF) and the consciousness of the patient improved gradually. However, on the ninth day of the hospitalization, the patient became febrile and confused; white blood cell count was 7920/mm3, protein level was 1952 mg/l in the CSF examination. Nosocomial meningitis was diagnosed and empirical treatment with ceftazidime (3 x 2 g/day) and vancomycin (4 x 500 mg/day) was started. CSF culture revealed growth of gram-positive cocci which were identified as Leuconostoc spp. by VITEK 2 Compact (Biomerieux, France) and Phoenix Instrument (Becton-Dickinson, USA) systems. Since the isolate was found susceptible to penicillin, ampicillin, cefotaxime, cefepime, chloramphenicol, clindamycin, erythromycin and linezolid, and resistant to vancomycin by disk diffusion and miniAPI ATB STREP 5 (Biomerieux, France) methods, the treatment was switched to linezolid (2 x 600 mg/day). Vancomycin and teicoplanin resistance was confirmed by E-test. The treatment was continued with linezolid and the patient's clinical condition improved after 14 days of treatment. The possible way of Leuconostoc transmission in this case was thought to be the lumbar punctures performed during the follow-up of subarachnoid hemorrhage. This presentation which demonstrated that Leuconostoc spp. might rarely lead to meningitis, also pointed out that when a vancomycin resistant gram-positive coccus was identified, Leuconostoc spp. should always be kept in mind.