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Published on: February 29, 2020
Bacterial meningitis due to the Streptococcus mitis group in children with cerebrospinal fluid leak
Haruka Fukayama1,2, Kensuke Shoji3, Michiko Yoshida3
1National Center for Child Health and Development, Department of General Pediatrics and Interdisciplinary Medicine, Tokyo, Japan.
Abstract:
The Streptococcus mitis group constitutes a part of the oral flora in humans and has been reported to cause infective endocarditis, brain abscesses, sepsis, pneumonia, and peritonitis. However, the S. mitis group rarely causes meningitis in children. We experienced a case of bacterial meningitis due to the S. mitis group in a 14-year-old girl with Gorham-Stout disease undergoing treatment with sirolimus for skull base osteolysis and cerebrospinal fluid (CSF) leak. Antibiotic treatment was initiated with linezolid and levofloxacin due to allergies against β-lactam antibiotics. On the third treatment day, antibiotics were switched to penicillin G according to CSF culture results, which were positive for penicillin-susceptible S. mitis group. Antibiotic therapy was successfully completed after 14 days without any neurological sequelae. There have apparently been no reports of S. mitis meningitis in pediatric patients with skull base osteolysis and CSF leak as in our case. Our findings suggest that clinicians should be aware of the possibility of S. mitis meningitis for patients with skull base osteolysis and/or CSF leakage.
Insights
This case study highlights a rare instance of Streptococcus mitis meningitis in a pediatric patient with Gorham-Stout disease and a cerebrospinal fluid leak. Prompt antibiotic treatment led to a successful recovery without neurological complications.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Neurology
Background:
- The Streptococcus mitis group is a common oral bacterium, typically associated with infections like endocarditis and sepsis.
- Meningitis caused by the Streptococcus mitis group is rare in children, especially in those with underlying skull base abnormalities.
Observation:
- A 14-year-old girl with Gorham-Stout disease, skull base osteolysis, and cerebrospinal fluid (CSF) leak developed bacterial meningitis.
- Initial antibiotic treatment included linezolid and levofloxacin due to beta-lactam allergies.
- CSF cultures identified penicillin-susceptible Streptococcus mitis, leading to a switch to penicillin G therapy.
Findings:
- The patient received 14 days of successful antibiotic treatment for Streptococcus mitis meningitis.
- No neurological sequelae were observed following the treatment.
- This represents a unique case of pediatric Streptococcus mitis meningitis associated with skull base osteolysis and CSF leak.
Implications:
- Clinicians should consider Streptococcus mitis as a potential pathogen in pediatric meningitis cases involving skull base osteolysis and/or CSF leaks.
- Early diagnosis and appropriate antibiotic selection are crucial for favorable outcomes in such rare infections.
- This case expands the known spectrum of infections caused by the Streptococcus mitis group in immunocompromised pediatric patients.
