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Adult pneumococcal meningitis with no inflammatory cells in the CSF
1Department of Internal Medicine, Faculty of Medicine, Addis Abeba University.
Abstract:
An 18 year old male patient was admitted to the Medical Intensive Care Unit of the Tikur Anbessa Hospital in October 1988. He was in deep coma and had findings consistent with a left lobar pneumonia. Lumbar puncture revealed a turbid CSF. Gram stain on both centrifuged and uncentrifuged specimens revealed plenty of gram positive diplococci with no single inflammatory cell. CSF culture proved the organism to be Streptococcus pneumoniae. The patient was put on combination of high doses of intravenous sodium-penicillin and chloramphenicol with all appropriate supportive management. However, the patient died only after three hours of stay in the hospital. The condition of diminished to absent inflammatory response in the CSF associated with pneumococcal meningitis in adults is discussed with a review of the literature.
Insights
A rare case of Streptococcus pneumoniae meningitis in an 18-year-old male presented with absent inflammatory cells in cerebrospinal fluid (CSF). Despite prompt treatment, the patient experienced a fatal outcome, highlighting unusual presentations of pneumococcal meningitis.
Area of Science:
- Neurology
- Infectious Diseases
- Microbiology
Background:
- Pneumococcal meningitis is a serious infection often characterized by an inflammatory response in the cerebrospinal fluid (CSF).
- Early diagnosis and treatment are crucial for patient outcomes.
Observation:
- An 18-year-old male presented with deep coma and left lobar pneumonia.
- Lumbar puncture revealed turbid CSF with Gram-positive diplococci (Streptococcus pneumoniae) but notably, no inflammatory cells.
- The patient received high-dose intravenous antibiotics (sodium-penicillin and chloramphenicol) and supportive care.
Findings:
- Despite aggressive treatment, the patient succumbed to the infection within three hours of hospital admission.
- The case highlights a rare presentation of pneumococcal meningitis with a diminished to absent inflammatory response in the CSF.
Implications:
- This case underscores the importance of considering atypical presentations of bacterial meningitis, even in the absence of typical inflammatory markers.
- Further research into the mechanisms behind absent inflammatory responses in severe bacterial meningitis is warranted.
- Understanding such variations can aid in earlier recognition and potentially improved management strategies for fulminant pneumococcal meningitis.