Kader ARSLAN, Salih CESUR, Şükran SEVİM, Ayşe BÜYÜKDEMİRCİ, Çiğdem HATİPOĞLU ATAMAN, Sami KINIKLI

Kronik alkol kullanımı olan bir hastada kafa travmasını takiben gelişen penisiline dirençli pnömokok menenjiti

Kronik alkol kullanan bireylerde santral sinir sistemi infeksiyonu bulguları baskılanabilir veya alkol yoksunluk sendromu gibi klinik durumlarla karışabilir. Alkolik hastalarda mikroorganizmalara karşı immun yanıtın etkilenmesi, malnutrisyon ve vitamin eksikliği gibi nedenlerle infeksiyon etkenlerine karşı duyarlılık artar. Bu hastalarda en sık görülen menenjit etkeni Streptococcus pneumoniae’dır. Pnömokoklarda penisilin direnci son yıllarda tüm dünyada ve Türkiye’de önemli bir endişe kaynağıdır. Penisiline yüksek düzey dirençli pnömokok infeksiyonlarının tedavisinde üçüncü kuşak sefalosporinler (seftriakson, sefotaksim) ve vankomisin kombinasyonu ile birlikte deksametazon tedavisi tercih edilir. Pnömokokal menenjitte tanı ve tedavide gecikme olması durumunda mortalite oranı yüksektir. Bu yazıda, kronik alkol kullanımı öyküsü olan 40 yaşında bir erkek hastada kafa travmasını takiben gelişen, geç tanı konulan ve mortal seyreden penisiline dirençli Streptococcus pneumoniae menenjiti olgusu sunuldu.

Anahtar Kelimeler:

Alkolik hasta, kafa travması, menenjit, penisiline dirençli pnömokok

Penicillin-resistant pneumococcal meningitis following a head trauma in a chronic alcoholic patient

Chronic alcohol use may suppress central nervous system infections or interfere with clinical conditions such as alcohol withdrawal syndrome. Sensitivity to infectious agents is increased in alcoholic patients due to the impaired immunological response to microorganisms, malnutrition and vitamin deficiency. The most common meningitis in these patients is Streptococcus pneumoniae. Penicillin resistance in pneumococci, is a major source of concern in recent years all over the world and in Turkey. In the treatment of pneumococcal infections, which are highly resistant to penicillin, a combination of third-generation cephalosporins (ceftriaxone, cefotaxime) and vancomycin is applied along with dexamethasone therapy. If there is a delay in the diagnosis and treatment of pneumococcal meningitis, the mortality rate is high. In this article, we present a 40-year-old male patient with chronic alcohol use history who was diagnosed with penicillin-resistant Streptococcus pneumoniae meningitis with delayed diagnosis and mortality which was developed after a head trauma.

Keywords:

Alcoholic head trauma, meningitis, penicillin-resistant pneumococcus,

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