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Streptococcus Oralis meningitis from right sphenoid Meningoencephalocele and cerebrospinal fluid leak
Kishan Patel1, Zain Memon2, Adam Prince2
1Department of Internal Medicine, Zucker School of Medicine at Hofstra Northwell, Lenox Hill Hospital New York, New York, USA. KPatel36@northwell.edu.
Background:
Streptococcus oralis belongs to the Streptococcus mitis group and is part of the normal flora of the nasal and oropharynx (Koneman et al., The Gram-positive cocci part II: streptococci, enterococci and the 'Streptococcus-like' bacteria. Color atlas and textbook of diagnostic microbiology, 1997). Streptococcus oralis is implicated in meningitis in patients with decreased immune function or from surgical manipulation of the central nervous system. We report a unique case of meningitis by Streptococcus oralis in a 58-year-old patient with cerebral spinal fluid leak due to right sphenoid meningoencephalocele.
Case Presentation:
A 58-year-old female presented in the emergency department due to altered mental status, fevers, and nuchal rigidity. Blood cultures were positive for Streptococcus oralis. Magnetic resonance stereotactic imaging of head with intravenous gadolinium showed debris in lateral ventricle occipital horn and dural thickening/enhancement consistent with meningitis. There was also a right sphenoidal roof defect, and meningoencephalocele with cerebrospinal fluid leak as a result. The patient was treated with ceftriaxone and had endoscopic endonasal repair of defect. She had complete neurologic recovery 3 months later.
Conclusions:
Cerebrospinal fluid leak puts patients at increased risk for meningitis. Our case is unique in highlighting Streptococcus oralis as the organism implicated in meningitis due to cerebrospinal fluid leak.
Insights
This case highlights Streptococcus oralis meningitis in a patient with a cerebrospinal fluid leak due to a sphenoid meningoencephalocele. Prompt treatment led to complete neurologic recovery.
Area of Science:
- Neurology
- Infectious Diseases
- Microbiology
Background:
- Streptococcus oralis is a common bacterium found in the upper respiratory tract.
- It can cause meningitis, particularly in immunocompromised individuals or after neurosurgery.
Observation:
- A 58-year-old female presented with fever, altered mental status, and nuchal rigidity.
- Imaging revealed meningitis, a right sphenoid meningoencephalocele, and cerebrospinal fluid leak.
- Blood cultures identified Streptococcus oralis as the causative agent.
Findings:
- Cerebrospinal fluid leaks significantly increase the risk of meningitis.
- This case uniquely identifies Streptococcus oralis as the pathogen in meningitis secondary to a cerebrospinal fluid leak.
Implications:
- Early diagnosis and treatment of cerebrospinal fluid leaks are crucial for preventing meningitis.
- Understanding the role of Streptococcus oralis in this context can inform clinical management and improve patient outcomes.
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