Pneumococcal Meningitis during Pregnancy: A Case Report and Review of Literature

Abstract

Background. Bacterial meningitis is a medical emergency for which prompt diagnosis and treatment are imperative to reducing the rate of death and long-term neurologic compromise. Few cases of meningitis have been reported during pregnancy, many of which had devastating outcomes for mother, neonate, or both. Case. A 38-year-old multigravida at 35 weeks of gestation presented with mental status changes, fever, and preterm contractions. Lumbar puncture revealed gram positive cocci consistent with S. pneumoniae. Patient was intubated and admitted to ICU where she was given antibiotics and adjunctive therapy with dexamethasone. Continuous fetal monitoring was utilized throughout her course of her hospitalization. Patient was discharged home after ten days in the hospital and had an uncomplicated vaginal birth after caesarean section (VBAC) at 38 weeks. Both she and the infant are doing well with no permanent neurologic sequelae. Conclusion. A review of literature indicates only isolated cases of pneumococcal meningitis being described during pregnancy. An extended period of time between onset of maternal illness and delivery appears to reduce the risk of neonatal transmission and improve both maternal and fetal outcomes.

Bacterial meningitis in pregnancy: report of six cases and review of the literature

“…Patients in our cases-series were relatively old compared with previous studies of pneumococcal meningitis during pregnancy [7][8][9][10][11][12][13][14][15][16][17]: four of six women were over 35 years. This is probably explained by the higher age of childbearing in the Netherlands [33].…”

“…Six of the 25 cases of pneumococcal meningitis during pregnancy were included in a previous review study [7], and 15 were reported in a Nigerian case series performed from 1958 to 1962 (Table 2) [15]. Combining these patients with Landrum [7] Bakaya [17] Vives [13] Felisati [16] Iinuma [14] Present study The patient had a miscarriage shortly before admission and died on the 16th day of admission.…”

“…Six of the 25 cases of pneumococcal meningitis during pregnancy were included in a previous review study [7], and 15 were reported in a Nigerian case series performed from 1958 to 1962 (Table 2) [15]. Combining these patients with those from our case series, we found the average age was 33 years and all 31 patients were multigravida.…”

“…A total of 42 cases of bacterial meningitis during pregnancy were reported. The most common causative microorganisms were S. pneumoniae (25 cases; 60%) and L. monocytogenes (seven cases; 17%) [7][8][9][10][11][12][13][14][15][16][17][18][19]. Pathogens in other cases were Neisseria meningitidis (two), Haemophilus influenzae (one), Group A streptococci (two), Group B streptococci (two), Neisseria gonorrhoea (two) and Pasteurella multocida (one) [20][21][22][23][24][25][26][27][28][29].…”

Postpartum maternal pneumococcal meningitis complicated by endocarditis

“…Maternal meningitis due to S. pneumoniae during pregnancy and postpartum is very rare (2–9). In this case report, we describe a patient who developed fever and mental status changes during the postpartum period and was subsequently diagnosed with maternal pneumococcal meningitis complicated by endocarditis.…”