[Streptococcus pneumoniae meningitis treated successfully with polymyxin B-immobilized fiber therapy: a case report]

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Nephrology

Background:

• Bacterial meningitis, particularly Streptococcus pneumoniae, can lead to severe neurological complications and systemic inflammatory responses.
• Standard treatments including antibiotics and corticosteroids may not always suffice in severe cases, necessitating novel therapeutic strategies.
• Systemic inflammatory response syndrome (SIRS) and disseminated intravascular coagulation (DIC) are critical complications of severe bacterial meningitis.

Observation:

• A 61-year-old male presented with fever and altered consciousness, diagnosed with Streptococcus pneumoniae meningitis.
• Despite initial treatment with dexamethasone and antibiotics, the patient developed SIRS, DIC, and status epilepticus.
• Polymyxin B-immobilized fiber (PMX) therapy was initiated to manage endotoxin and inflammatory mediators.

Findings:

• Following PMX therapy, the patient showed immediate improvement in consciousness and resolution of DIC and SIRS.
• Cerebrospinal fluid (CSF) analysis revealed decreased concentrations of pro-inflammatory cytokines, including IL-1, IL-2, and TNF-α.
• Urinary antigen detection confirmed Streptococcus pneumoniae as the causative agent.

Implications:

• Polymyxin B-immobilized fiber (PMX) therapy demonstrates potential as an adjunctive treatment for severe bacterial meningitis.
• PMX therapy may mitigate severe inflammatory responses and complications like DIC in bacterial meningitis.
• This case highlights the utility of PMX in managing critically ill patients with bacterial meningitis and associated systemic inflammation.