Recurrent Streptococcus pneumoniae Meningitis

Davachi, Farzin; Bregu, Hamide; Lito, G.

doi:10.1093/tropej/48.4.249

Cited by 6 publications

(9 citation statements)

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“…It is particularly more difficult to make diagnosis in young children and infants because of the patient's inability to give a detailed history. All sites of the skull‐base leakage may be the source of bacterial communication 1,2,5–7 . Although our patient had a trauma history, he had no otorrhea or rhinorrhea.…”

Section: Discussionmentioning

confidence: 78%

“…A complete blood count, total immunoglobulin levels, immunoglobulin‐G subclasses, and complement levels should be performed in these patients. Terminal complement components (C5–C8) have an active bactericidal effect and their deficiency may lead to recurrent Neisseria meningitis 2 . Splenic function can be examined using a liver/spleen radionucleotide scan if there is history or bloodwork suggesting of hyposplenia 1 .…”

Section: Discussionmentioning

confidence: 99%

“… Acute bacterial meningitis is a potentially life‐threatening infection of the cranial and spinal leptomeninges. Recurrent episodes of meningitis are rarely seen, but when they occur, an extensive investigation has to be made to find out responsible factors 1–3 . A single episode of acute meningitis may result from bacteriemia, but when followed by recurrent meningitis in pediatric patients, other possible routes of the bacteria invasion to the cerebrospinal fluid (CSF) should be considered 1 …”

mentioning

confidence: 99%

“…The underlying cause is a transdural communication between the meningeal space and paranasal sinuses or skin. The first attack of meningitis may occur several weeks to 12 years after the head injury 2,4–6 . In addition, recurrent bacterial meningitis may be due to disorders of the immune system, such as complement deficiency.…”

mentioning

confidence: 99%

“…The fi rst attack of meningitis may occur several weeks to 12 years after the head injury. 2,[4][5][6] In addition, recurrent bacterial meningitis may be due to disorders of the immune system, such as complement defi ciency. We report a 14-year-old boy, who suffered from recurrent Streptococcus pneumoniae meningitis due to a well-defi ned defect at the ethmoid roof after a head trauma.…”

mentioning

confidence: 99%

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Recurrent Streptococcus pneumoniae meningitis in a child with traumatic anterior cranial base defect

Kendirli

Ünay

Tosun

et al. 2006

Pediatrics International

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Acute bacterial meningitis is a potentially life-threatening infection of the cranial and spinal leptomeninges. Recurrent episodes of meningitis are rarely seen, but when they occur, an extensive investigation has to be made to find out responsible factors. A single episode of acute meningitis may result from bacteriemia, but when followed by recurrent meningitis in pediatric patients, other possible routes of the bacteria invasion to the cerebrospinal fluid (CSF) should be considered. Patients with head injury have the highest risk of acquiring recurrent bacterial meningitis, followed by patients with a congenital anatomic lesion of the skull or duramater, such as meningomyelocele. The underlying cause is a transdural communication between the meningeal space and paranasal sinuses or skin. The first attack of meningitis may occur several weeks to 12 years after the head injury. In addition, recurrent bacterial meningitis may be due to disorders of the immune system, such as complement deficiency. We report a 14-year-old boy, who suffered from recurrent Streptococcus pneumoniae meningitis due to a well-defined defect at the ethmoid roof after a head trauma.

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Recurrent Streptococcus pneumoniae meningitis in a child with traumatic anterior cranial base defect

Kendirli

Ünay

Tosun

et al. 2006

Pediatrics International

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Recurrent bacterial meningitis: A new reason to wear a seat belt while driving

Németh

Crook

Glagola

et al. 2010

Journal of Hospital Medicine

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Recurrent bacterial meningitis (RBM), particularly when caused by Streptococcus pneumoniae, warrants an aggressive and thorough evaluation to exclude transdural communication. We present an unusual case of RBM as a late manifestation of a traumatic head injury sustained 10 years prior and describe presentation, etiology, diagnosis, and treatment options for RBM. Case ReportA middle-aged woman with type 2 diabetes mellitus, hypertension, and a prior history of S. pneumoniae meningitis 1 year earlier, presented to an outside hospital with complaints of fever, headache, and change in mental status. Materials for basic laboratory tests and blood cultures were drawn in the Emergency Department; these showed diabetic ketoacidosis. Computed tomography (CT) scan of the head was negative and a lumbar puncture (LP) was attempted, but was unsuccessful. The patient was started on intravenous insulin drip, vancomycin, and ceftriaxone and was transported to our facility via Life-Flight. She also developed acute respiratory failure requiring mechanical ventilation.After arrival, the patient had a normal repeat CT scan of her head and a successful LP. Cerebrospinal fluid (CSF) revealed 9064 white blood cells (WBCs)/mm 3 with 77% neutrophils and 9% lymphocytes, protein concentration of 275 mg/dL, and glucose of 93 mg/dL. CSF culture and Gram stain were negative, while 1 blood culture drawn at the outside hospital grew penicillin-resistant S. pneumoniae (MIC 2 lg/ mL). WBC count was 9660/mm 3 with 45% band forms. Bacterial meningitis was confirmed and the patient was continued on intravenous antibiotics and insulin drip. Additional laboratory studies revealed normal complement levels and a negative human immunodeficiency virus (HIV) 1 and HIV 2 antibody screen. The patient was extubated in 48 hours. and was treated with a total of 2 weeks of ceftriaxone and vancomycin for penicillin-resistant S. pneumoniae meningitis.The patient had an uneventful full recovery and was discharged from the hospital with neurosurgery follow-up. The neurosurgeon ordered a CT scan of the facial bones, which revealed an irregular calcification in the right frontal sinus adjacent to the cribriform plate and thinning of the posterior wall of the sinus. Upon requestioning at a subsequent neurosurgical appointment, the patient recalled being an unrestrained passenger and striking her head against the windshield in a motor vehicle accident (MVA) approximately 10 years ago. Ever since the MVA, she noticed intermittent postnasal discharge while recumbent. However, she never sought a medical opinion and denied complaints of anterior rhinorrhea.A CT cisternography confirmed the presence of CSF leakage with contrast accumulation via a defect in the right paramedian cribriform plate. Contrast opacification was seen in the fovea ethmoidalis extending into the right frontal sinus (Figure 1). The patient subsequently underwent transnasal endoscopic CSF leak repair (Figure 2). The postoperative cisternogram did not reveal the transdural communication. However a follow...

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