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Streptococcus pneumoniae Serotype 23B Causing Asymptomatic Sinusitis Complicated by Endocarditis and Meningitis:

Saliha Erdem1, Dhruvil Patel1, Suraj V Patel2

  • 1Internal Medicine, Wayne State University School of Medicine, Detroit, USA.

Cureus
|August 15, 2023
PubMed

Insights

A rare Streptococcus pneumoniae infection caused severe mitral valve endocarditis and meningitis in a young adult. Prompt surgical intervention and antibiotics led to full recovery, highlighting potential cryptic sinus sources.

Area of Science:

  • Infectious Diseases
  • Cardiology
  • Neurology

Background:

  • Streptococcus pneumoniae (S. pneumoniae) can cause severe invasive infections.
  • Mitral valve endocarditis and bacterial meningitis are serious conditions requiring prompt diagnosis and treatment.

Observation:

  • A previously healthy young adult male presented with altered mentation, indicative of potential central nervous system involvement.
  • Incidental mucosal thickening in paranasal sinuses suggested a cryptic primary infection source.
  • Blood and cerebrospinal fluid cultures identified S. pneumoniae serotype 23B.

Findings:

  • The patient developed mitral valve endocarditis and bacterial meningitis concurrently.
  • Despite childhood pneumococcal vaccinations, infection with S. pneumoniae serotype 23B occurred.
  • Surgical mitral valve replacement and ceftriaxone treatment were crucial for recovery.

Implications:

  • This case underscores the importance of considering non-respiratory sources, such as paranasal sinuses, for invasive pneumococcal infections.
  • It highlights the potential for S. pneumoniae to cause severe, disseminated disease even in vaccinated individuals.
  • Successful management involved a multidisciplinary approach combining surgical and antimicrobial therapies.
Keywords:
austrian triadcomplicated infective endocarditisosler's triadpcv13pneumococcal bacteremiapneumococcal meningitispneumococcal vaccineppsv23serotype 23bstreptococcus pneumoniae meningitis

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