Tsetsa Georgieva DOİCHİNOVA, Galya İvanova GANCHEVA, Stefan İvanov MİRCHEV, Nachko İliev TOTSEV

Otogenic meningoencephalitis caused by Streptococcus pneumoniae

Streptococcus pneumoniae’nın sebep olduğu menenjit/meningoensefalitler ağır bir seyrederler ve yüksek mortalite gösterirler. Burada kronik bilateral otitis media ve mastoidite seconder olarak gelişen ciddi seyirli bir S. pneumoniae olgusu sunuldu. Otuz yedi yaşında erkek hasta ateş, eksitasyon, somnolans ve menings irritasyon bulguları ile başvurdu. Beyin omurilik sıvısı (BOS) incelemesinde artmış protein seviyesi (11,3 g/L), lökosit sayısı µL’de 59790 (%93’ü nötrofil) ve çok düşük düzeyde glukoz düzeyi (0,1 mmol/L) bulundu. S. pneumoniae’nın etken olduğu BOS’tan yapılan lateks testi ve kültürle doğrulandı. Bilgisayarlı tomografi ile bilateral otitis media ve mastoidit olduğu gösterildi. Seftazidim ve devamında sefepim ve şeklinde antibakteriyel tedavi, destek tedavisi ve kortikosteroid uygulaması yanında bilateral kortikal mastoidektomi yapıldı. Hasta hızlı bir iyileşme gösterdi ve hastanede 17 gün süren bir tedaviden sonra normal klinik ve laboratuvar bulgularla taburcu edildi. Sonuç olarak hem cerrahi hem de konservatif tedavi kronik mastoidite sekonder olan ve S. pneumoniae’nın etken olduğu menenjit/ meningoensefalitlerde akıbet için hayati önem taşırlar

Anahtar Kelimeler:

Streptococcus pneumonia, menenjit, meningoensefalit, mastoidit

Otogenic meningoencephalitis caused by Streptococcus pneumoniae

Tsetsa Georgieva Doichinova, Galya Ivanova Gancheva, Stefan Ivanov Mirchev, Nachko Iliev Totsev Meningitis/ meningoencephalitis due to Streptococcus pneumoniae are with severe course and high mortality rate. A case of severe meningoencephalitis by S.pneumoniae secondary to chronic bilateral otitis and mastoiditis is presented here. A 37-year-old male patient was admitted with fever, excitation, somnolence and meningeal irritation. Investigation of cerebrospinal fluid (CSF) revealed increased protein level (11.3 g/L), leucocytes count 59,790/μL (93% neutrophils), extremely decreased glucose level (0.1 mmol/L). S.pneumoniae was confirmed by latex test and culture of CSF. Otitis media and mastoiditis were found bilaterally by computerized tomography. Bilateral cortical mastoidectomy was performed together with antibacterial treatment by consequently ceftazidime and cefepime and corticosteroids were administered. He experienced progressive improvement and was discharged with normal laboratory parameters and without sequels after 17 days hospital treatment. In conclusion, both surgical and conservative treatments are crucial for outcome of meningitis/ meningoencephalitis by S.pneumoniae secondary to chronic mastoiditis.

Keywords:

Streptococcus pneumoniae,

PDF

___

Braun YS, Sublet JE, Freyer D, et al. Pneumococcal pneumolysin and H2O2 mediate brain cell apoptosis during meningitis. J Clin Invest 2002;109:19-27.
Hirst RA, Kadioglu A, O’Callaghan C, Andrew PW. The role of pneumolysin in pneumococcal pneumonia and meningitis. Clin and Exper Immunol 2004;138:195-201.
Scheld WM, Koedel U, Nathan B, Pfister HW. Pathophysiology of bacterial meningitis: mechanism(s) of neuronal injury. J Infect Dis 2002;186 (Suppl 2):S225-33.
Koedel U, Scheld WM, Pfister HW. Pathogenesis and patho- physiology of pneumococcal meningitis. The Lancet Infect Dis 2002;2:721-736.
Doichinova T, Ilieva P. Pneumococcal meningoencephalitis. Мedinfo 2010;6:50-52. (Bulgarian)
Yochev S, Genev G, Boyadzhiyan H. Scientific papers on Third National conference about bacterial infections and immunology. 1974:777-782. (Bulgarian)
Kaneva J. In: Bacterial meningitis. Sofia: Medicine and Physical Culture, 1986:69-77. (Bulgarian)
Henrichs AM. Pneumococcal meningitis making comeback. Pitts- burgh Tribune-Rev, Jan 15,2009.
Doichinova T, Jordanova-Laleva P, Ilieva P. Comparative studies at bacterial meningitis caused by S. pneumoniae and N. meningiti- dis. General medicine 2007;3:26-29. (Bulgarian)
Porto G. Aspectos da moderna terapeutica. Revista Brasileira de Otorrinolaringologia 1940;8:689-700.
Sakamoto M, Ito K, Sugasawa M, Taniguchi M. Otogenic Menin- gitis Caused by the Pneumococci that had Acquired Resistance to Cephalosporins. Otolaryngology - Head and Neck Surgery (OTO) 2001;124:350-351.
Van de Beek D, de Gans J. Dexamethasone and pneumococcal meningitis. Ann Intern Med 2004;141:327.
Firat M, Ersoy Y, Eşel D, Bayraktar M, Caylan R, Durmaz R. Antimicrobial susceptibility and serotype distribution of pneu- mococci strains isolated from meningitis patients. Mikrobiyol Bul 2006;40:169-77.
Totan M. Recurrent pneumococcal meningitis in homozygous C3 deficiency. Indian J Pediatr 2002;69:625-6.
Yurtseven T, Suntur BM, Sipahi OR, Büke Ç, Büke M. Does Ri- fampin and Ceftriaxone Can be an Alternative to Vancomycin and Ceftriaxone in Experimental Penicillin and Cephalosporin- Resistant Pneumococcal Meningitis? J Neurol Scienc (Turkish) 2005;22 ):29-34.
Ahmed A, Jafri H, Lustar I, et al. Pharmacodynamics of vancomy- cin for the treatment of experimental penicillin and cephalosporin resistant pneumococcal meningitis. Antimicrob Agents Chemoth- er 1999;43:876-881.
Hizel K, Güzel O, Altunçekiç A, Gür D, Arman D. Case report: dif- ficulty in treating one event of Streptococcus pneumoniae men- ingitis. Mikrobiyol Bul 2003;37:65-69.
Dubos F, Marechal I, Husson MO, Courouble C, Aurel M, Marti- not A. Decline in pneumococcal meningitis after the introduction of the heptavalent-pneumococcal conjugate vaccine in northern France. Archives of disease in childhood 2007;92:1009-1012.
Hoogman M, van de Beek D, Weisfelt M, de Gans J, Schmand B. Cognitive outcome in adults after bacterial meningitis. J Neurol Neurosurg Psychiatry 2007;78:1092-1096.