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Propionibacterium acnes meningitis in a previously normal adult
Archives of Internal Medicine
|July 1, 1977
Summary
Acute Propionibacterium acnes meningitis can present atypically, mimicking other neurological conditions. Early and appropriate treatment, guided by more than sensitivity data, is crucial to prevent chronic meningitis.
Area of Science:
- Neurology
- Infectious Diseases
- Microbiology
Background:
- Diphtheroid meningitis is a rare form of bacterial meningitis.
- Propionibacterium acnes is a common cause of diphtheroid meningitis.
Observation:
- A previously healthy 25-year-old man developed acute Propionibacterium acnes meningitis.
- The patient presented with stroke-like syndromes, an afebrile course, and cerebrospinal fluid showing mononuclear pleocytosis with normal glucose.
- These features are atypical for acute bacterial meningitis.
Findings:
- The case highlights that diphtheroid meningitis can manifest with non-characteristic symptoms.
- In vitro sensitivity data alone may be insufficient for guiding antimicrobial therapy.
- Chloramphenicol may achieve better tissue levels than penicillin for diphtheroid meningitis.
Implications:
- Clinicians should consider diphtheroid meningitis in patients with atypical meningitis presentations.
- Cerebrospinal fluid isolates of diphtheroids should not be dismissed as contaminants.
- Optimal antimicrobial selection and dosage are critical to prevent relapse and chronic meningitis.