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[Stomatococcus mucilaginosus meningitis in immunocompromised child]
H Ben Salah1, F Crockaert, J Levy
1Unité d'hémato-oncologie, hôpital universitaire des enfants, Bruxelles, Belgique.
Background:
Opportunistic infections are responsible for significant morbidity and mortality in patients with malignancy developing granulocytopenia as a result of therapy. A case of Stomatococcus mucilaginosus meningitis is reported.
Case Report:
A 2 year-old boy was admitted because he had developed fever and neutropenia during chemotherapy given for neuroectodermal tumor. He was previously treated for a Stomatococcus mucilaginosus septicemia with vancomycin given for 15 days through an intravenous catheter which has subsequently been left in place. At admission, fever was associated with severe degree of aplasia (70 WBC/mm3). The patient was given IV ceftazidime plus amikacin. Two days later, the boy developed acute meningitis due to Stomatococcus mucilaginosus; he was then given IV vancomycin (40 mg/kg/d) and imipenem (100 mg/kg/d). Persistence of abnormal clinical and bacteriological findings required subsequent intrathecal administration of vancomycin (1.5 mg/d) for 5 days. CSF cultures were negative 2 days later, leading to stop IV antibiotics after 3 weeks. The catheter was removed 1 week later.
Conclusion:
This patient represents the third reported case of Stomatococcus mucilaginosus meningitis. Combined intrathecal and systemic administration of vancomycin seems to have been useful in our case.
Insights
This case report details a rare instance of Stomatococcus mucilaginosus meningitis in a child undergoing chemotherapy. Combined intravenous and intrathecal vancomycin treatment proved effective in clearing the infection.
Area of Science:
- Infectious Diseases
- Pediatric Oncology
- Neuroscience
Background:
- Opportunistic infections pose significant risks for cancer patients with therapy-induced granulocytopenia.
- Stomatococcus mucilaginosus is an uncommon pathogen, rarely implicated in serious infections like meningitis.
Observation:
- A 2-year-old boy with neuroectodermal tumor developed fever and neutropenia during chemotherapy.
- He had a prior Stomatococcus mucilaginosus septicemia treated with vancomycin, with an indwelling catheter left in place.
- Meningitis due to Stomatococcus mucilaginosus developed despite initial antibiotic treatment.
Findings:
- The patient presented with severe aplasia (70 WBC/mm3) and subsequently developed Stomatococcus mucilaginosus meningitis.
- Treatment involved intravenous vancomycin and imipenem, followed by intrathecal vancomycin due to persistent infection.
- Cerebrospinal fluid cultures became negative after intrathecal vancomycin administration, leading to treatment cessation.
Implications:
- This case highlights the potential for Stomatococcus mucilaginosus to cause meningitis in immunocompromised pediatric patients.
- Combined intrathecal and systemic vancomycin therapy may be a viable treatment strategy for this rare condition.
- Management of indwelling catheters in neutropenic patients requires careful consideration to prevent opportunistic infections.