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[Purulent meningitis in an adult patient caused by multi-drug resistant Streptococcus pneumoniae 19A]
G Vukmirovits1, R Nikolova, R Todorova
1Központi Anaesthesiologiai és Intenzív Betegellátó Osztály, Fóvárosi Szent László Kórház, Budapest.
Unlabelled:
This is the first report in Hungary about meningitis caused by multiply-resistant Streptococcus pneumoniae in a 54 year old woman. The Streptococcus pneumoniae serotype 19A was highly resistant to penicillin, ampicillin, chloramphenicol, cefuroxime and intermediate resistant to ceftriaxone. The antibiotic treatment was started with penicillin and ampicillin. The antibiotic treatment was changed to vancomycin + ceftriaxone, vancomycin + rifampicin and vancomycin + imipenem on the 2nd, 4th and 11th hospital days, respectively. She died on the 29th day with symptoms of sepsis. Necropsy and microscopic examination of the brain revealed localised inspissed layer of purulent exsudat over the convexities. Under this area the small wessels and capillaries were thrombotic and were surrounded by severe degeneration and necrosis in the white matter.
Recommendations:
Streptococcus pneumoniae has to be considered penicillin resistant until the organism is proved to be susceptible to penicillin. The authors advise the administration of dexamethasone, based on their own favourable 7 years experience.
Insights
This case report details Hungary's first instance of meningitis caused by multi-drug resistant Streptococcus pneumoniae. Despite intensive antibiotic therapy, the patient succumbed to sepsis, highlighting the critical need for vigilance against resistant bacterial strains.
Area of Science:
- Infectious Diseases
- Microbiology
- Neurology
Background:
- Meningitis is a serious infection of the membranes surrounding the brain and spinal cord.
- Streptococcus pneumoniae is a common cause of bacterial meningitis.
- The emergence of antibiotic-resistant strains poses a significant public health challenge.
Observation:
- A 54-year-old woman in Hungary presented with meningitis caused by a multiply-resistant Streptococcus pneumoniae serotype 19A.
- The isolate exhibited high resistance to penicillin, ampicillin, chloramphenicol, and cefuroxime, with intermediate resistance to ceftriaxone.
- Despite multiple antibiotic regimen changes, including vancomycin combinations, the patient developed sepsis and died on the 29th hospital day.
Findings:
- Post-mortem examination revealed purulent exudate, thrombotic vessels, and severe white matter degeneration and necrosis in the brain.
- The case underscores the limited treatment options and poor prognosis associated with highly resistant Streptococcus pneumoniae infections.
- Penicillin resistance in Streptococcus pneumoniae should be assumed unless susceptibility is confirmed.
Implications:
- This case highlights the critical need for surveillance and rapid identification of multi-drug resistant Streptococcus pneumoniae.
- Effective treatment strategies for resistant meningitis require careful consideration of antibiotic combinations and adjunctive therapies.
- The authors recommend considering dexamethasone administration based on favorable clinical experience.