Pneumococcal meningitis secondary to otitis media in two patients with COVID-19 omicron variant

Abstract

Background The SARS-CoV-2 omicron variant produces more symptoms in the upper respiratory tract than in the lower respiratory tract. This form of “common cold” can cause inflammation of the oropharynx and the Eustachian tube, leading to the multiplication of bacteria such as Streptococcus pneumoniae in the oropharynx. Eustachian tube dysfunction facilitates migration of these bacteria to the middle ear, causing inflammation and infection (otitis media), which in turn could lead to further complications such as acute mastoiditis and meningitis. Case presentation In January 2022, during the rapid spread of the omicron variant of the SARS-CoV-2 virus, two patients presented to the emergency room at our hospital complaining of headache and a low level of consciousness. A few days prior to admission, the patients had been diagnosed with COVID-19 based on clinical manifestations of a cold virus, without respiratory failure. Cranial computed tomography revealed signs of bilateral invasion of the middle ear in both cases. Lumbar puncture was compatible with acute bacterial meningitis, and S. pneumoniae was isolated in cerebrospinal fluid in both patients. RT-PCR tests for SARS-CoV-2 were repeated, confirming the presence of the omicron variant in one of the patients. We were unable to confirm the variant in the second patient due to the low viral load in the nasopharyngeal sample obtained at admission. However, the time of diagnosis (i.e., during the peak spread of the omicron variant), strongly suggest the presence of the omicron variant. Both patients were admitted to the intensive care unit and both showed rapid clinical improvement after initiation of antibiotic treatment. Conclusions The omicron variant of the SARS-CoV-2 virus can promote the development of otitis media and secondary acute bacterial meningitis. S. pneumoniae is one of the main bacteria involved in this process.

Streptococcus salivarius Probiotics to Prevent Acute Otitis Media in Children

“…Furthermore, the study was conducted before the emergence of SARS-CoV-2 variants such as the Omicron variant. The SARS-CoV-2 variants may promote the evolution of viral respiratory symptoms to AOM, similarly to the rhinovirus . Had the study been conducted during circulation of different SARS-CoV-2 variants, with a higher incidence of AOM, it might have yielded different results.…”

“…The SARS-CoV-2 variants may promote the evolution of viral respiratory symptoms to AOM, similarly to the rhinovirus. 31 Had the study been conducted during circulation of different SARS-CoV-2 variants, with a higher incidence of AOM, it might have yielded different results. In addition, our commercially available chewable tablet for children 3 years or older included L rhamnosus GG and P shermanii in addition to S salivarius K12.…”

The Causal Effect of COVID-19 on Chronic Mastoiditis: A Bidirectional Two-Sample Mendelian Randomization-Based Study

“…7 However, a study based on the Uni ed Health System (SUS) of Brazil showed that during the COVID-19 pandemic, hospitalizations for mastoiditis in children under 9 years old decreased. 8 As chronic mastoiditis has hidden features, whilst the uncontrolled infection of petrous part of temporal bone can lead to serious intracranial and extracranial infections (there have been reports of Pneumococcal meningitis following otomastoiditis in COVID-19 patients 9 ), a thorough investigation of the relationship between COVID-19 and chronic mastoiditis is particularly important.…”

COVID-19 and Listeria Meningitis Treated by Ampicillin, Sulfamethoxazole/Trimethoprim and Meropenem

“…In addition, not only pneumonia, but also other invasive infectious diseases including meningitis were considered as COVID-19-associated bacterial infections in the omicron era, although the rate of bacterial meningitis was also decreased in the early phase of the COVID-19 pandemic. 6,7 It has been reported that the omicron variant of SARS-CoV-2 induces more symptoms in the upper respiratory tract than in the lower respiratory tract, and this form of "common cold" could lead to inflammation of the Eustachian tube and the oropharynx, and such dysfunction enhances the migration of bacteria, such as Haemophilus influenzae and Streptococcus pneumoniae to the middle ear, causing otitis media, which in turn could lead to further complications including acute meningitis and mastoiditis. 6 Listeria monocytogenes is a Gram-positive bacillus and facultative intracellular bacterium, and listeriosis is considered to be among the most common bacterial foodborne infections.…”

“…6,7 It has been reported that the omicron variant of SARS-CoV-2 induces more symptoms in the upper respiratory tract than in the lower respiratory tract, and this form of "common cold" could lead to inflammation of the Eustachian tube and the oropharynx, and such dysfunction enhances the migration of bacteria, such as Haemophilus influenzae and Streptococcus pneumoniae to the middle ear, causing otitis media, which in turn could lead to further complications including acute meningitis and mastoiditis. 6 Listeria monocytogenes is a Gram-positive bacillus and facultative intracellular bacterium, and listeriosis is considered to be among the most common bacterial foodborne infections. 8 The large majority of listeriosis cases are sporadic, but outbreaks occur after contamination of soft cheeses or ready-to-eat food, and L. monocytogenes was discovered on at least one food specimen in the refrigerators of 64% of 123 patients with L. monocytogenes infection.…”