© Borgis - New Medicine 4/2013, s. 126-128
Jolanta Jadczyszyn, *Lidia Zawadzka-Głos, Małgorzata Dębska
Meningitis and encephalitis of the etiology of Streptococcus pneumoniae – a case report
Department of Pediatric Otolaryngology, Medical University of Warsaw, Poland
Head of Department: Lidia Zawadzka-Głos, MD, PhD
Meningitis occurs with infiltration of a soft and a spider as a result of penetration of bacteria into the fluid of the temporal bone. Most often caused by Haemophilus influenzae type b (Hib) and Streptococcus pneumoniae. In children, acute otitis media is four times more common cause of intracranial and infratemporal complications than chronic inflammation. Predominant intracranial complications in children is meningitis. The diagnosis is based on an examination of cerebrospinal fluid. The treatment consists of removal of the focus of purulent otitis media and intensive antibiotic therapy.
Intracranial complications involve children and young people more often than adults (1, 2). They mainly occur in the course of acute otitis media, rarely -in chronic otitis media with cholosteatoma or granulation tissue (1, 3). The most common complication is meningitis (2, 4, 5). The characteristic symptoms of meningitis and encephalitis are: persistent fever (including septic fever), headache, nausea and vomiting, confusion, agitation, seizures and meningeal signs (neck stiffness, positive Brudzinski sign). The predominant pathogens are the most common intracranial complications pneumococcus, Pseudomonas, sticks G (-), rarely stick G (+) and fungus (1, 4). The infection spreads to the interior of the skull directly to the inflamed bone, its natural or traumatic loss, by veins or anatomical connections with ear structures and skull structures. The course of complications depends on a patient’s immune response, coexisting diseases, treatment, pathogenic bacteria and their sensitivity to antibiotics.
A 4-year-old boy was admitted to Children’s Hospital in Warsaw with severe conditions. 6:45 because of the seizure of the short-term loss of consciousness with associated vomiting, which occurred at night. A 3-day Medical history: fever to 40°C, headache, and catharal otitis media left, the patient isn’t treated with an antibiotic. In the case the patient suffered from otitis several times. Last otitis media treated with antibiotics a month ago. In addition, this history is without any strains When examined, the patient conscious, pale skin with features of dehydration, stiff neck, eyes flat, narrow lazily react to light, exotropia. Lung and heart auscultation was normal. Efficient respiratory and circulatory. BP 115/80 mmHg, HR 100 bpm, breaths 30/min, saturation of 100% without oxygen, TPR 38.6°C. In laboratory studies increased markers of inflammation and D-dimers (tab. 1).
Table 1. Laboratory tests.
|Tests||1 day||3-4 day|
|WBC (4.5-13 thous.)||31.7||13.8|
|RBC (4.3-5.5 mln)||4.47||2.92|
|HB (10.9-14.2 g/dl)||12.7||8.3|
|PLT (250-550 thous.)||259||213|
|APTT (26-36 sec.)||29.07||44.26|
|D-dimery (170-550 ug/L)||3127||3039|
|CRP (0-1 mg/dl)||22.2||29.1|
|Fibrynogen (2-4 g/l)||8.03||11.31|
|AST (15-40 U/L)||17||105|
|ALT (10-35 U/L)||16||33|
Taken blood culture and cerebrospinal fluid before turning on intravenous antibiotics (Vancomycin and Biotaksym). About hrs. 9:08 made head CT with contrast. It was airless mastoid cells, and cells of the tympanic cavity top of the pyramid of the temporal bone on the left side, segmental breaking the continuity of lamina inner the mastoid process around the left sigmoid sinus. Brain tissue without change (fig. 1).
Fig. 1. Mastoiditis on the left side.
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1. Otolaryngologia dziecięca, red. M. Chmielik, PZWL; Warszawa 2006. 2. Samuel J, Fernandes CMC, Steinberg JL: Intracranial otogenic complications: a persisting problem. The Laryngoscope 1986, 96; 3: 272-278. 3. Skotnicka B: Complications of otitis media in children in the era of antybioticotherapy. Otolaryngol Pol 2007; 61(5): 779-783. 4. Kangsanarak J, Navacharoen N, Fooanant S, Ruckphaopunt K: Intracranial Complications of Suppurative Otitis Media: 13 Years’ Experience. American Journal of Otology; 1995: 104-109. 5. Migirov L, Duvdevani S, Kronenberg J: Otogenic intracranial complications: a review of 28 cases. Acta Otolaryngol 2005; 125(8): 819-822. 6. Ciorba A, Berto A, Borgonzoni M, Grasso DL et al.: Pneumocephalus and meningitis as a complication of acute otitis media: case report. Acta OtorhinolaryngolItal 2007; 27(2): 87-89. 7. Otolaryngologia dziecięca, red. D. Gryczyńska, Alfa-Medica Press; Bielsko-Biała 2007. 8. Otolaryngologia kliniczna, red. A. Zakrzewski, PZWL; Warszawa 1981. 9. Damergis JA, Chee K, Amitai A: Otogenic pneumococcal meningitis with pneumocephalus. Emerg Med 2010; 39(3): 109-112. 10. Janczewski G: Otolaryngologia praktyczna, Via Medica; Gdańsk 2005.