Purulent Meningitis as an Unusual Presentation ofStaphylococcus aureusEndocarditis: A Case Report and Literature Review

Abstract

On presentation of Staphylococcus aureus endocarditis, unusual manifestations may represent the main clinical features of the disease. Isolated bacterial meningitis as the first manifestation of endocarditis is considered to be an unusual neurological complication. Here, we describe a case S. aureus endocarditis presenting as isolated meningitis and mimicking meningococcal septicaemia. Because of the high mortality rate of the disease, the prompt recognition of this infectious syndrome is of crucial importance for the correct management of patients.

An Altered Adolescent

“…Bacterial endocarditis is relatively rare in healthy children and adolescents with no known congenital heart disease and presentation can be variable and non-specific. 15 It should be considered in any patient with bacterial meningitis with unusual blood or CSF culture isolates.…”

“…Bacterial endocarditis is relatively rare in healthy children and adolescents with no known congenital heart disease and presentation can be variable and non-specific. 15 It should be considered in any patient with bacterial meningitis with unusual blood or CSF culture isolates. or Community-acquired enterococci, in the absence of a primary focus Persistent bacteremia Persistently positive blood culture, defined as recovery of a microorganism consistent with infective endocarditis from blood cultures drawn more than 12 hours apart or Persistently positive blood culture, defined as recovery of a microorganism consistent with infective endocarditis from all of 3 or a majority of 4 or more separate blood cultures, with first and last drawn at least 1 hour apart Single positive blood culture for Coxiella burnetti or phase I antibody titer >1:800 Evidence of endocardial involvement on echocardiogram Positive findings: oscillating intracardiac mass, on valve or supporting structures, or in the path of regurgitant jets, or on implanted material, in the absence of an alternative anatomic explanation or myocardial abscess or new partial dehiscence of prosthetic valve New valvular regurgitation (increase or change in preexisting murmur not sufficient)…”

Thinking out of the cranial box in meningitis

“…Endocarditis is difficult to diagnose initially due to absence of a murmur in up to 30% of the cases at the time of presentation. 3 Differentiating patients with uncomplicated S. aureus bacteremia from those with underlying IE is often challenging. S. aureus meningitis usually presents with a primary focus of infection, either pneumonia or endocarditis.…”

“…The neurologic complications of infective endocarditis (IE) usually occur as a result of embolization from the cardiac vegetation 2 . Some of these manifestations include ischemic stroke (40%–50%), cerebral hemorrhage (12%–30%), and brain abscess (5%) 3 . Nonspecific neurological manifestations include headache, seizures, and toxic non‐focal encephalopathy.…”

Purulent meningitis caused by Rhodococcus equi

“…Clinically, purulent meningitis usually manifests as fever, vomiting, headache, and meningeal irritation. [ 1 ] The most common pathogens are Pneumococcus , Hemophilus influenzae , and Staphylococcus. [ 2 ] However, purulent meningitis due to Rhodococcus equi is extremely rare.…”