Annals of Clinical Microbiology, The official Journal of the Korean Society of Clinical Microbiology

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pISSN 2288-0585 eISSN 2288-6850

A Case of Streptococcus salivarius Meningitis in a Patient with Cerebrospinal Fluid Rhinorrhea after Skull Base Fracture

Case report

Annals of Clinical Microbiology (Ann Clin Microbiol) 2009 June, Volume 12, Issue 2, pages 92-96.

https://doi.org/10.5145/ACM.2009.12.2.92

A Case of Streptococcus salivarius Meningitis in a Patient with Cerebrospinal Fluid Rhinorrhea after Skull Base Fracture

Kyeong Seob Shin1, Dong Ik Shin2, Woo Sub Shim3, Byeong Cheol Rim4, Il Hun Bae5, Seung Young Lee5, Dong Hee Ryu6, Eun Jung Kim7, Bo Ra Son1
Departments of 1Laboratory Medicine, 2Neurology, 3Otorhinolaryngology-Head and Neck Surgery, 4Neurosurgery, 5Radiology and 6Surgery, Chungbuk National University College of Medicine, 7Department of Pathology, Chungbuk National University Hospital, Cheongju, Korea

Abstract

Streptococcus salivarius meningitis is very uncommon, and most cases are iatrogenic, occurring after invasive procedures such as spinal anesthesia or lumbar puncture etc.. Post-traumatic occurrence of this infection is especially rare. A 20-year-old man with a previous history of skull base fracture was seen at the emergency department with signs of acute bacterial meningitis. The CSF had a few gram positive cocci with neutrophilic pleocytosis, which were identified as S. salivarius by the Vitek system (bioMerioux, Inc., Hazelwood, MO, USA), rapid ID 32 Strep (bioMerieux, Marcy-l’Etoile, France) and 16S rRNA sequencing. The microorganism showed intermediate resistance to penicillin (MIC=0.25μg/mL) but was susceptible to cefotaxime (MIC=0.25μg/mL) and vancomycin (MIC= 0.75μg/mL). The patient was treated with ceftriaxone and vancomycin. He also had his CSF leakage repaired by an endoscopic approach. To our knowledge, this is the first case of S. salivarius meningitis reported in Korea. (Korean J Clin Microbiol 2009;12: 92-96)

Keywords

Streptococcus salivarius, Meningitis, Skull fracture, Basilar