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Meningitis Due to Streptococcus salivarius

2001; American Society for Microbiology; Volume: 39; Issue: 8 Linguagem: Inglês

10.1128/jcm.39.8.3017.2001

1098-660X

Pedro Idígoras, Adoración Valiente, Luis Iglesias, Patrick Trieu‐Cuot, Claire Poyart,

Otolaryngology and Infectious Diseases

Streptococcus salivarius is a common inhabitant of the oral mucosa that has been associated with infection in different sites (4). Meningeal infection by this species, generally related to neoplasias or iatrogenia, has been described on few occasions (1, 2, 6). We describe two cases recently diagnosed in our hospital. Case 1. An 84-year-old male was admitted for intestinal subocclusion due to an adenocarcinoma of the rectum. Ten days after admission the patient’s general condition began to deteriorate and developed fever and nuchal rigidity. The cerebrospinal fluid (CSF) yielded 7,680 leukocytes/ml (95% were polymorphonuclears), 726 mg of protein per dl, and undetectable glucose. Empiric treatment was initiated with ceftazidime (2 g every 6 h), ampicillin (2 g every 4 h), and vancomycin (1 g every 12 h). Streptococci were isolated from the CSF and by culture from one blood sample. Therapy was changed to ampicillin (2 g every 4 h) and gentamicin (80 mg every 8 h). The patient was discharged 22 days later in satisfactory condition. Case 2. A 65-year-old woman who underwent surgery for meniscectomy with epidural anesthesia returned to the hospital 4 days after surgery due to headache, general discomfort, chills, and vomiting that had continued since the day after the meniscectomy. CSF analysis revealed 580 leukocytes/ml (95% were polymorphonuclears), 108 mg of protein per dl, and 26 mg of glucose per dl. The patient, who was allergic to penicillin, was treated empirically with vancomycin (1 g every 12 h) and tobramycin (300 mg every 24 h). A streptococcus was isolated from the CSF. Tobramycin therapy was discontinued, and clindamycin therapy (600 mg every 12 h), was initiated. The patient recovered in 7 days without sequelae. The first case appeared to be an example of an invasive streptococcal infection originating from the large intestine in a patient with intestinal neoplasia and is similar to the other cases described in the literature (1). In the second case, the microorganism was probably introduced at the time the puncture was made for the epidural anesthesia, a risk which has also been reported previously (6). Gram’s staining of the CSF was negative in both patients. Both isolates were identified by phenotypic methods and genetic analysis. In phenotypic analyses, both strains hydrolyzed esculin in the presence of 4% bile and yielded a positive reaction with Lancefield group D antiserum. It was not possible to identify these streptococci to the species level by using