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Propionibacterium acnes meningitis in a previously normal adult
Abstract:
A 25-year-old man was previously healthy until he contracted acute Propionibacterium acnes meningitis. Comparison with previous reports of de novo diphtheroid meningitis suggests that this entity can appear with features that are not characteristic of acute bacterial meningitis, including (1) stroke-like syndromes, (2) an afebrile course, and (3) a cerebrospinal fluid with a mononuclear pleocytosis and normal glucose level. The appropriate choice and dosage of antimicrobial agent must be guided by more than in vitro sensitivity data to prevent relapse and possible chronic meningitis. Although diphtheroids are as a rule exquisitely sensitive to penicillin, predictably high tissue levels of drug in diphtheroid meningitis are best achieved with chloramphenicol treatment. In the appropriate settling, the isolation of diphtheroids from cerebrospinal fluid should not be discounted as a "contaminant."
Insights
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.