Delayed cerebral ischaemic injury following apparent recovery from Streptococcus pneumoniae meningitis

Area of Science:

• Neurology
• Infectious Diseases
• Critical Care Medicine

Background:

• Streptococcus pneumoniae meningitis is a serious infection.
• Early treatment with antimicrobials and corticosteroids improves outcomes.
• Neurological complications can still occur despite treatment.

Purpose of the Study:

• To report a case series of patients with Streptococcus pneumoniae meningitis.
• To investigate the development of severe neurological complications despite treatment.
• To discuss the potential role of persistent inflammation and limitations of steroid therapy.

Main Methods:

• Case report of two patients admitted with fever and altered consciousness.
• Diagnosis confirmed by cerebrospinal fluid (CSF) culture for Streptococcus pneumoniae.
• Treatment included antimicrobial therapy and dexamethasone.
• Neurological status and brain imaging (CT) monitored during treatment.

Main Results:

• Initial rapid neurological improvement after antimicrobial and dexamethasone therapy.
• Cerebrospinal fluid cultures became sterile.
• Subsequent neurological deterioration with worsening consciousness.
• Development of extensive brain ischaemic lesions leading to death.
• Brain CT scans on admission showed no specific lesions.

Conclusions:

• Severe brain ischaemic complications can occur in Streptococcus pneumoniae meningitis even after initial treatment response.
• Persistent inflammation may contribute to these delayed ischaemic events.
• Short courses of high-dose steroids may not be sufficient to prevent such severe complications.