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Case report: anaerobic meningitis caused by Peptostreptococcus magnus after head and neck surgery
M A Brown1, J N Greene, R L Sandin
1Department of Medicine, University of South Florida College of Medicine, Tampa.
Abstract:
Although anaerobic bacterial meningitis is uncommon, patients subjected to resection of head and neck malignancy appear at special risk. In this article, the authors report on a 72-year-old man in whom meningitis developed after extensive resection of the right sinuses for squamous cell carcinoma; initial treatment consisted of intravenous vancomycin and ceftazidime. Intravenous penicillin G was added after the fortuitous early finding of intracellular cocci in Wright-Giemsa stained cerebral spinal fluid submitted for cell count. Cerebral spinal fluid cultures then grew out a pure culture of Peptostreptococcus magnus. The patient had a complete recovery, without neurologic sequelae, recurrence of malignancy, or evidence of infection. Appropriate handling of cerebral spinal fluid specimens is crucial to ensure the correct diagnosis when anaerobic organisms are suspected.
Insights
Anaerobic bacterial meningitis, though rare, poses a risk for patients undergoing head and neck cancer surgery. Early diagnosis via cerebrospinal fluid analysis is crucial for effective treatment and recovery.
Area of Science:
- Neurology
- Infectious Diseases
- Oncology
Background:
- Head and neck cancer resection patients are at increased risk for uncommon anaerobic bacterial meningitis.
- Squamous cell carcinoma in the sinuses can lead to serious infections post-surgery.
Observation:
- A 72-year-old male developed meningitis after extensive sinus surgery for squamous cell carcinoma.
- Initial treatment included vancomycin and ceftazidime.
- Intracellular cocci were observed in cerebrospinal fluid (CSF) via Wright-Giemsa stain.
Findings:
- Cerebrospinal fluid cultures confirmed a pure growth of Peptostreptococcus magnus.
- The patient received additional intravenous penicillin G.
- Complete recovery was achieved without neurological deficits or recurrence of infection.
Implications:
- This case highlights the importance of suspecting anaerobic meningitis in at-risk patients.
- Proper handling and analysis of CSF specimens are critical for diagnosing anaerobic bacterial meningitis.
- Prompt and accurate diagnosis leads to effective treatment and favorable patient outcomes.