Streptococcus salivarius Meningitis in Immunocompetent: A Case Report

Abstract

Streptococcus salivarius (S. salivarius) is a rare cause of purulent meningitis. We report a case of meningitis due to S. salivarius in 15-years-old Sudanese boy. Diagnosis was established based on Cerebrospinal fluid (CSF) findings. The patient responded well to systemic antibiotics and recovered completely without any neurological complications after proper supportive measures. In this patient the meningitis caused by S. salivarius was thought to be spontaneous. The importance of bacteriological diagnosis and proper antibiotic treatment for S. salivarius meningitis is discussed. KeywordsStreptococcus salivarius, Meningitis, Immunocompetent, Cerebrospinal fluid is a Joint commission international (JCI) accredited, with a history of high grade of fever 2 days ago, intermittent, relieved by paracetamol, severe headache and generalized fatigability. On day of admission, he developed one episode of tonic clonic convulsion at home and three times in emergency room. He was intubated and admitted in ICU.Assessment of vital signs on presentation revealed a temperature of 39.2 °C, pulse of 112 beats per minute, and blood pressure of 88/50 mmHg. The physical examination revealed that the patient was toxic, and irritable. Cardiovascular and respiratory systems were normal. Laboratory investigations revealed hemoglobin 13.4 g/dl, total leukocyte count 26.400 cells per cubic millimeter. Liver and renal function, serum electrolytes, calcium and magnesium were within normal limits.The patient have no history of epidural anesthesia, spinal myelography, post-traumatic cerebrospinal fluid leaks, brain abscesses, pericranial fistulas or other procedures associated with S. salivarius contamination and also have no recent contact with meningitis patients.In view of suspected central nervous system infection, lumbar puncture was done. Cerebrospinal fluid (CSF) analysis showed an elevated protein level of 169 mg/dl (reference range, 15 to 45) and decrease glucose concentration of 5.8 mg/dl (reference range of 40 to 70 mg/dl). Gram stain of CSF showed no bacteria, but white blood cells were increased 16 cells/cm, with 56% neutrophils and 44% lymphocytes. With the conclusion of pyogenic meningitis, patient was started on intravenous ceftriaxone (2 gm/12 h), vancomycin (1 gm/12 h)