Meningitis Due toGemella haemolysansin a Pediatric Case

Abstract

Gemella haemolysans is a rare pathogen in cases of bacterial meningitis. We present a case of meningitis due to G. haemolysans in a 17-month-old boy. This is the first reported case of Gemella meningitis in a child. The patient completely recovered following intravenous therapy with linezolid and chloramphenicol.A 17-month-old boy who was diagnosed at the age of 2 months with complex congenital heart disease (a perimembranous ventricular septal defect and a small patent ductus arteriosus) was admitted to the hospital with complaints of fever, vomiting, and loss of appetite for 2 days. A physical examination revealed an ill-appearing baby with a head circumference of 46.5 cm, a weight of 10,500 g, and a height of 77 cm. His body temperature was 39.2°C, his heart rate was 164/min, and his respiratory rate was 28/min. The anterior fontanelle was closed, and he had a grade 2/6 systolic murmur at the left sternal border. There was no hepatomegaly or splenomegaly, and he had no sick contacts or trauma. He had received three doses of hepatitis B vaccine, as well as polio, diphtheria, tetanus toxoid, pertussis, and first Bacille Calmette-Guerin (recommended in the childhood immunization schedule in Turkey) vaccines, and had not received Haemophilus influenzae type b vaccine (recommended in the childhood immunization schedule in Turkey for 3 months). His medications included digoxin and spironalactone because of heart disease. There was no family history of invasive bacterial infection. Blood, cerebrospinal fluid (CSF), and urine samples were taken and sent to the laboratory for culture and biochemical analyses. The complete blood count showed a white blood cell count of 21,830/mm 3 , of which 74% were neutrophils, 8% were bands, 16% were lymphocytes, and 2% were monocytes; a hemoglobin level of 11.9 g/dl; and a platelet count of 170,000/mm 3 . His serum basic chemistry was normal, except for a glucose level of 183 mg/dl. The level of C-reactive protein was 30.4 mg/dl, and the erythrocyte sedimentation rate was 56 mm/h. Serum immunoglobulin and subclass levels were normal, and the serum was negative for anti-HIV antibody. Urine analysis and a chest radiograph were normal. Transthoracic echocardiography was negative for endocarditis. CSF analyses showed a protein concentration of 102 mg/dl, a glucose concentration of 11 mg/dl, a red blood cell count of 250/mm 3 , and a white blood cell count of 4,500/mm 3 , of which 88% were neutrophils and 12% were lymphocytes. The CSF was negative by gram staining. The diagnosis was suspicion of bacterial meningitis, and empirical antibiotic treatment was started with ampicillin (300 mg/kg/ day) and cefotaxime (200 mg/kg/day) as part of our clinical protocol. Dexamethasone (0.6 mg/kg/day, 4 days) was given intravenously before the first administrated antibiotic dose. The CSF specimen was cultured on 5% sheep blood, eosinmethylene blue, and chocolate agars at 35°C in 5 to 10% CO 2 for 48 to 72 h. Because of a suspicion of endocarditis, three pairs of aerobic and anaerobic blood cultures,...

Use of linezolid in pediatrics: a critical review

“…47 There is only one reported case in which linezolid was used for the treatment of Gemella infection; this was a CNS infection due to G. haemolysans in a child, with an excellent outcome. 21 Although G. haemolysans isolated from clinical specimens in the past have usually been sensitive to penicillin G and ampicillin, recent data suggest an emerging resistance. 21,48 Prompt appropriate treatment of infections due to Gemella spp can usually lead to a favorable outcome, but due to their increasing resistance, the use of linezolid should be considered.…”

“…Specifically, three cases have been ventriculoperitoneal (VP)-shunt infections, two meningitis (one with ventriculitis), two brain abscesses, and one ventriculitis. [16][17][18][19][20][21][22][23] Other less common types of infections have been bacteremia (AE endocarditis), pneumonia, and skin/soft tissue as well as bone infections. [24][25][26][27][28][29][30][31][32][33] The most common isolates against which linezolid has been used are Staphylococcus spp, either MRSA or MRSE, followed by Enterococcus spp, either VRE or E. faecalis.…”

“…Another rare case was a 17-month-old boy who suffered from complex congenital heart disease. 21 He developed meningitis due to Gemella haemolysans belonging to the family of Streptococcaceae. The isolate was resistant to penicillin, ceftazidime, ceftriaxone, clindamycin, levofloxacin and vancomycin and susceptible to linezolid and chloramphenicol.…”

Gemella haemolysans spondylodiscitis

“…Generally, infections caused by Gemella species are associated with immunocompromised states such as cancer, heart disease or poor dental hygiene. 12 However, there have been reports of infection, including life-threatening sepsis, in previously healthy patients with normal immune status. 2,10 Both our patients were previously healthy, and apart from the controlled hypothyroidism and hypertension in There is also early involvement of the T11 vertebral body.…”

A Case of Spondylodiscitis and Paraspinal Abscess Due to Gemella haemolysans

“…Oral kavite, üst solunum yolu, gastrointestinal sistem ve genitoüriner sistemin normal fl orasında bulunur (1). Literatürde G. haemolysans'ın etken olduğu endokardit, menenjit, beyin apsesi, endoftalmit, faringeal apse, ampiyem ve spondilodiskit olguları bildirilmiştir (2)(3)(4)(5)(6)(7)(8). Ülkemizde endemik olan tüberküloz ve bruselloz, spondilodiskitin başta gelen nedenleri arasındadır.…”