Viridans Streptococcal Meningitis Following Penetrating Cervical Injury

Abstract

Viridans streptococcal meningitis is a rare occurrence, usually as a result of iatrogenic invasion of the dural space or significant immunosuppression. We report a case of an otherwise healthy child who had Streptococcus salivarius meningitis as a result of lacerations to the posterior neck after a fall onto a drinking glass. Despite being well appearing on initial presentation, our patient had pneumocephalus on head computed tomography that was not initially recognized. He was discharged from the emergency department and subsequently returned within 24 hours with meningismus. This case highlights the increased risk of meningitis in patients with cerebrospinal fluid leak and the importance of radiographic signs that suggest a traumatic fistula may have occurred. To our knowledge, this is the first case of viridians streptococcal meningitis after penetrating trauma to the neck.

Streptococcus sanguinis meningitis following endoscopic ligation for oesophageal variceal haemorrhage

“…While viridans streptococci are considered to be bacteria of low virulence, they could cause invasive infections such as bacteraemia, endocarditis or, uncommonly, meningitis. Viridans streptocococcal meningitis is often associated with cranial trauma and neurosurgical procedure; the most common species reported are Streptococcus mitis and Streptococcus salivarius (Cabellos et al , 1999; Cantey & Tamma, 2011; Carley, 1992; Enting et al , 1997). S. sanguinis is more often associated with dental structures (Johnson & Tunkel, 2005), and has also been described as a pathogen of meningitis following a neurosurgical procedure or vacuum extraction (Alba et al , 1994; Berga & Trierweiler, 1989; Heath et al , 1980).…”

“…Viridans streptococci, although a common cause of endocarditis, are rarely associated with bacterial meningitis and account for less than 1 % of all cases of purulent meningitis (Carley, 1992). Cases of meningitis due to viridans streptococci have been commonly preceded by neurosurgical procedures such as ventriculoperitoneal shunting, spinal anaesthesia, myelography and trauma (Alba et al , 1994; Baer, 2006; Cantey & Tamma, 2011; Schneeberger et al , 1996; Yaniv & Potasman, 2000); gastrointestinal haemorrhage and manipulation such as endoscopic ligation are rarely reported to be related to meningitis. We report herein a case of Streptococcus sanguinis meningitis following endoscopic ligation for oesophageal variceal haemorrhage in a patient with cirrhosis of the liver.…”