Ebru AZAPAĞASI, Tanıl KENDİRLİ, Serhan ÖZCAN, Gökçen Öz TUNCER, Halil ÖZDEMİR, Ömer Suat FİTÖZ, Erdal İNCE

A case of fulminant pneumococcus meningoencephalitis progressing with white matter involvement despite two doses of conjugated pneumococcus vaccine

Background. Streptococcus pneumonia is a cause of serious mortality and morbidity, especially among small children. However, currently, it causes lower rates of invasive infections due to successful vaccination programs.Case. We report an exceptional case of a 6-month-old child with meningoencephalitis caused by Streptococcus pneumonia despite the administration of two doses of pneumococcal conjugate vaccine (PCV). Meningitis progressed rapidly and led to widespread damage in parenchymal brain tissue with the emergence of fulminant meningoencephalitis. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed widespread brain lesions, suggesting extensive parenchymal injury. Conclusion. Such diffuse white matter lesions among pediatric patients with Streptococcus pneumoniameningoencephalitis despite two doses of PCV have not been reported previously.

PDF

___

1. Bridy-Pappas AE, Margolis MB, Center KJ, Isaacman DJ. Streptococcus pneumoniae: description of the pathogen, disease epidemiology, treatment, and prevention. Pharmacotherapy 2005; 25: 1193-1212.

2. Whitney CG, Farley MM, Hadler J, et al; Active Bacterial Core Surveillance of the Emerging Infections Program Network. Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine. N Engl J Med 2003; 348: 1737-1746.

3. Grijalva CG, Nuorti JP, Arbogast PG, Martin SW, Edwards KM, Griffin MR. Decline in pneumonia admissions after routine childhood immunisation with pneumococcal conjugate vaccine in the USA: a time-series analysis. Lancet 2007; 369: 1179-1186.

4. Kang SJ, Kim HY, Kim YS, Lee HN, Kim HT, Kim SH. Intractable pneumococcal meningoencephalitis associated with a TNF-α antagonist. J Neurol Sci 2014; 344: 215-218.

5. Jorens PG, Parizel PM, Wojciechowski M, et al. Streptococcus pneumoniae meningoencephalitis with unusual and widespread white matter lesions. Eur J Paediatr Neurol 2008; 12: 127-132.

6. Jorens PG, Parizel PM, Demey HE, et al. Meningoencephalitis caused by Streptococcus pneumoniae: a diagnostic and therapeutic challenge. Diagnosis with diffusion-weighted MRI leading to treatment with corticosteroids. Neuroradiology 2005; 47: 758-764

7. Magnus J, Parizel PM, Ceulemans B, Cras P, Luijks M, Jorens PG. Streptococcus pneumoniae meningoencephalitis with bilateral basal ganglia necrosis: an unusual complication due to vasculitis. J Child Neurol 2011; 26: 1438-1443.

8. Jit M. The risk of sequelae due to pneumococcal meningitis in high-income countries: a systematic review and meta-analysis. J Infect 2010; 61: 114-124.

9. Katchanov J, Heuschmann PU, Endres M, Weber JR. Cerebral infarction in bacterial meningitis: predictive factors and outcome. J Neurol 2010; 257: 716-720.

10. Snyder RD, Stovring J, Cushing AH, Davis LE, Hardy TL. Cerebral infarction in childhood bacterial meningitis. J Neurol Neurosurg Psychiatry 1981; 44: 581-585.

11. Tibussek D, Sinclair A, Yau I, et al. Late-onset group B streptococcal meningitis has cerebrovascular complications. J Pediatr 2015; 166: 1187-1192.e1.

12. Ceyhan M, Ozsurekci Y, Gurler N, et al. Distribution of Streptococcus pneumoniae serotypes that cause parapneumonic empyema in Turkey. Clin Vaccine Immunol 2013; 20: 972-976.

13. Wittebole X, Duprez T, Hantson P. Delayed cerebral ischaemic injury following apparent recovery from Streptococcus pneumoniae meningitis. Acta Clin Belg 2016; 71: 343-346.

14. Vernino S, Wijdicks EF, McGough PF. Coma in fulminant pneumococcal meningitis: new MRI observations. Neurology 1998; 51: 1200-1202.

15. Johkura K, Nishiyama T, Kuroiwa Y. Bilateral basal ganglia infarctions in a patient with Streptococcus pneumoniae meningitis. Eur Neurol 2002; 48: 123- 124.

16. Pugin D, Copin JC, Goodyear MC, Landis T, Gasche Y. Persisting vasculitis after pneumococcal meningitis. Neurocrit Care 2006; 4: 237-240.

17. Oligbu G, Collins S, Andrews N, et al. Characteristics and serotype distribution of childhood cases of invasive pneumococcal disease following pneumococcal conjugate vaccination in England and Wales, 2006-2014. Clin Infect Dis 2017; 65: 1191-1198.

18. Heininger U, Bachtiar NS, Bahri P, et al. The concept of vaccination failure. Vaccine 2012; 30: 1265-1268.

19. Tanir Basaranoglu S, Karadag Oncel E, Aykac K, et al. Invasive pneumococcal disease: from a tertiary care hospital in the post-vaccine era. Human Vaccin Immunother 2017; 13: 962-964.

20. Park SY, Van Beneden CA, Pilishvili T, Martin M, Facklam RR, Whitney CG; Active Bacterial Core surveillance team. Invasive pneumococcal infections among vaccinated children in the United States. J Pediatr 2010; 156: 478-483.e2.

21. Godot C, Levy C, Varon E, Picard C, Madhi F, Cohen R. Pneumococcal meningitis vaccine breakthroughs and failures after routine 7-valent and 13-valent pneumococcal conjugate vaccination in children in France. Pediatr Infect Dis J 2015; 34: e260-e263.

22. Ceyhan M, Ozsurekci Y, Gurler N, et al. Serotype distribution of Streptococcus pneumoniae in children with invasive diseases in turkey: 2008-2014. Hum Vaccin Immunother 2016; 12: 308-313.

23. Isapof A, Delacourt C, Reinert P, Cohen R, Madhi F. Serotype 19F pneumococcal meningitis in an imunocompetent infant immunized with heptavalent pneumococcal conjugated vaccine prevenar. Arch Pediatr 2009; 16: 1133-1136