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Meningitis due to penicillin-resistant Streptococcus pneumoniae in adults
R D Weingarten1, Z Markiewicz, D N Gilbert
1Department of Medicine, Providence Medical Center, Portland, Oregon 97213.
Abstract:
A 33-year-old woman with quiescent systemic lupus erythematosus developed meningitis due to a penicillin-resistant strain of Streptococcus pneumoniae. After an initial failure of penicillin therapy, the patient responded to cefotaxime. The meningitis was complicated by total neurosensory hearing loss. Howell-Jolly bodies noted on peripheral blood smear led to a radionuclide spleen scan, which documented functional asplenia. This woman is the second patient in the United States with meningitis caused by a strain of S. pneumoniae moderately resistant to penicillin G (minimal inhibitory concentration, 1.0 microgram/mL). The resistant isolate displayed resistance to penicillin that was not of enzymatic origin but rather was due to an alteration of penicillin-binding proteins. This experience illustrates the importance of testing the in vitro susceptibility of the pneumococcus to penicillin G.
Insights
A patient with systemic lupus erythematosus developed meningitis from penicillin-resistant Streptococcus pneumoniae. Prompt cefotaxime treatment and susceptibility testing are crucial for managing such infections, especially in asplenic individuals.
Area of Science:
- Infectious Diseases
- Neurology
- Rheumatology
Background:
- Systemic lupus erythematosus (SLE) can increase susceptibility to infections.
- Meningitis caused by Streptococcus pneumoniae is a serious complication.
- Emerging antibiotic resistance in Streptococcus pneumoniae poses a significant clinical challenge.