Rapid progressive destruction of the cochleae in an infant due to pneumococcal meningitis

Area of Science:

• Pediatrics
• Infectious Diseases
• Otolaryngology

Background:

• Pneumococcal conjugate vaccines have decreased Streptococcus pneumoniae infections but increased non-vaccine serotype prevalence.
• Emergence of drug-resistant S. pneumoniae strains poses ongoing public health challenges.

Purpose of the Study:

• To report a case of severe bilateral hearing impairment in a pediatric patient due to non-vaccine serotype S. pneumoniae meningitis.
• To highlight the importance of early otolaryngologist consultation in managing rapid cochlear destruction.

Main Methods:

• Case report of a 15-month-old female with suspected meningitis.
• Cerebrospinal fluid culture, auditory brainstem response, auditory steady-state response, and magnetic resonance imaging.
• Identification of S. pneumoniae serotype 10A with PBP2x mutation.

Main Results:

• The patient developed severe bilateral hearing impairment and cochlear fibrosis with labyrinthitis.
• The causative S. pneumoniae isolate was serotype 10A, a non-vaccine type with reduced cephalosporin susceptibility.
• Rapid cochlear destruction occurred despite appropriate initial antibiotic treatment.

Conclusions:

• Non-vaccine serotypes of S. pneumoniae can cause severe complications like hearing loss, even in vaccinated children.
• Prompt consultation with otolaryngologists is essential for timely surgical intervention (cochlear implantation) in cases of rapid cochlear damage.
• Pediatricians should maintain a high index of suspicion for hearing impairment in meningitis patients and seek specialist consultation early.