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Polymicrobial Bacterial Meningitis in a Patient with Chronic Suppurative Otitis Media: Case Report and Literature
Andrei Vâţă1,2, Erika Irimie-Băluţă1, Florin Manuel Roşu2,3
1Department of Infectious Diseases, "Grigore T. Popa" University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania.
Abstract:
Polymicrobial meningitis is a rare entity in the adult population, especially in the antibiotic era. However, disorders such as chronic suppurative otitis media (CSOM) or even poor oral hygiene are considered risk factors for the development of such cerebral infection. We report a case of polymicrobial meningitis associated with oto-mastoiditis in a 64-year-old female patient known to have CSOM. The patient presented atypical symptoms for community-acquired meningitis, showing subacute evolution of headache, without fever or neck stiffness. The aerobe microorganisms Streptococcus anginosus and Corynebacterium spp., sensitive to beta-lactamines, and the anaerobe Prevotella spp., resistant to penicillin and metronidazole, were isolated from CSF specimens, while Proteus mirabilis and Enterococcus faecalis were identified from the ear drainage. The diversity of pathogens identified in our case led us to the hypothesis of two different sources of meningitis: otogenic and/or odontogenic. Favorable evolution was obtained after a multi-disciplinary approach, combining surgery and broad-spectrum antibiotics. In addition, we performed a literature review that highlights the low incidence of polymicrobial mixed aerobe-anaerobe meningitis.
Insights
Polymicrobial meningitis, a rare adult infection, can arise from chronic suppurative otitis media or poor oral hygiene. A case highlights mixed aerobic and anaerobic bacteria, successfully treated with surgery and antibiotics.
Area of Science:
- Neurology
- Infectious Diseases
- Microbiology
Background:
- Polymicrobial meningitis is exceptionally rare in adults, particularly during the antibiotic era.
- Chronic suppurative otitis media (CSOM) and poor oral hygiene are identified risk factors for cerebral infections.
- This case presents a rare instance of polymicrobial meningitis linked to oto-mastoiditis in an adult patient with a history of CSOM.
Approach:
- A 64-year-old female patient with CSOM presented with atypical, subacute meningitis symptoms, including headache without fever or neck stiffness.
- Cerebrospinal fluid (CSF) analysis revealed aerobic bacteria (Streptococcus anginosus, Corynebacterium spp.) and an anaerobic bacterium (Prevotella spp.).
- Ear drainage cultures identified Proteus mirabilis and Enterococcus faecalis, suggesting potential otogenic and/or odontogenic sources.
Key Points:
- The isolated pathogens included beta-lactamine-sensitive aerobes and a penicillin/metronidazole-resistant anaerobe.
- A multidisciplinary approach involving surgical intervention and broad-spectrum antibiotics was crucial for treatment.
- The case underscores the diagnostic challenge posed by polymicrobial meningitis with diverse microbial profiles.
Conclusions:
- Favorable patient outcomes were achieved through combined surgical and antibiotic therapies.
- A literature review confirmed the low incidence of polymicrobial meningitis involving both aerobic and anaerobic bacteria in adults.
- This case emphasizes the importance of considering polymicrobial origins in meningitis, even in atypical presentations.
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