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Streptococcus gallolyticus subspecies gallolyticus is a catalasenegative gram-positive cocci, included in group D, nonenterococcal streptococci group of organisms. This organism is commonly thought to be associated with colonic cancer, but its association with bacterial meningitis is rather uncommon. Earlier known to be Streptococcus bovis, modern taxonomy has reclassified it as S. gallolyticus subsp gallolyticus. In this case report, we describe a rare case of adult meningitis caused by S. gallolyticus subsp gallolyticus secondary to hemorrhoids.S treptococcus bovis is part of normal flora of the gastrointestinal tract in 5% to 10% individuals. 1 It was first identified as a pathogen to cause endocarditis in the year 1970 in a patient with colonic cancer. 2 Modern taxonomy has delineated S. bovis into Streptococcus gallolyticus subsp gallolyticus (biotype I), S. gallolyticus subsp pasteurianus (biotype II/2), Streptococcus infantarius subsp coli (biotype II/1), and S. infantarius subsp infantarius (biotype II/1). 3 The first case of adult meningitis associated with S. bovis was reported in the year 1975. 4 It was later known that not all subspecies of S. bovis are associated with colonic cancer or meningitis. There have been 19 reported cases of adult meningitis, all due to S. gallolyticus subsp pasteurianus. 5 CASE REPORTA previously healthy 57-year-old man presented to the accident and emergency department with complaints of fever, headache, and altered sensorium. On examination, the patient was febrile, disoriented with neck stiffness, tachycardic with a heart rate of 110 beats per minute, and blood pressure of 110/80 mm Hg. Examination of the cardiac, respiratory, and gastrointestinal systems was unremarkable. Fundus examination was normal. Per rectal examination revealed a thrombosed hemorrhoid. The patient was a known case of diabetes on medication with no history of cardiac conditions or gastrointestinal problems. Peripheral blood samples were taken and treatment was started with ceftriaxone, due to the clinical diagnosis of community-acquired meningitis for a total of 4 weeks.Preliminary laboratory investigations revealed a hemoglobin level of 15 g%, total white blood cell count of 23,300 cells/mm 3 with neutrophils of 95% and lymphocytes of 5%. Liver function tests showed a serum bilirubin of 1.5 mg/dL, direct bilirubin of 0.6 mg/dL, indirect bilirubin of 0.9 mg/dL. Serum glutamic pyruvic transaminase level was 79 IU/L, alkaline phosphatase level was 257 IU/L, albumin level was 4.9 g/dL, globulin level was 2.9 g/dL, serum creatinine level was 0.9 mg/dL. Blood test was negative for human immunodeficiency virus, hepatitis B surface antigen, and hepatitis C antibody, Urine routine test showed 6 to 8 red blood cell counts, 6 to 8 pus cells, and no proteins. Serum sodium level was 129 mmol/L on presentation, which improved to 134 mmol/L subsequently.Computed tomography of the brain was normal, and magnetic resonance imaging, magnetic resonance arteriogram, and magnetic resonance venogram were noncontributory...

Background?Meningitis following neurosurgical procedure is a well-recognized and potentially fatal complication. The Indian literature on microbiological epidemiology is scarce. The aim of our study was to know clinical, microbiological profile and treatment outcomes of patients with neurosurgical meningitis at our center. Methods?This was a retrospective observational cohort study of 25 culture-proven neurosurgical meningitis cases performed at the Apollo Speciality Hospital, Chennai, India, between January 2009 and May 2012. Results?In our study, nine patients had skull fracture and cerebrospinal fluid leak, nearly 50% of the patients underwent craniotomy, and five patients had endoscopic surgery while 64% of the patients required shunt placement or drains. Only nine patients (36%) had definite clinical signs of meningitis and mean duration of onset of symptoms from surgery was 11.12 days. A total of 18 patients (72%) had gram-negative bacterial meningitis and majority (83.3%) was due to carbapenem-resistant organisms. Predominant isolate was Pseudomonas aeruginosa (44.4%), and the second most common isolate was Acinetobacter baumannii (33.3%). Among cases of gram-negative bacterial meningitis, patients who had carbapenem-resistant isolates were given combination antimicrobials (carbapenem/cefepime tazobactam with colistin/gentamicin) as per susceptibility via intravenous and intrathecal through the drain (extraventricular or lumbar). Only five patients (27.7%) had a complete cure. Conclusion?Gram-negative organisms, mainly Pseudomonas and Acinetobacter, are predominant pathogen in neurosurgical meningitis in our center. While treating multidrug-resistant gram-negative meningitis, device removal and a combination of antimicrobial agents via both intravenous and intraventricular routes are crucial to achieve cure.