Pneumococcal meningitis is caused by Streptococcus pneumoniae bacteria (also called pneumococcus, or S pneumoniae).This type of bacteria is the most common cause of bacterial meningitis in adults. We here report two cases of adult patients with pneumococcal meningitis with a normal cerebrospinal fluid leukocyte count and review eight other cases in the literature. Google Scholar. 10.1016/S0163-4453(94)91197-5. statement and If untreated, meningococcal meningitis is fatal in 50% of cases and may result in brain damage, hearing loss or disability in 10% to 20% of survivors. In addition to a low CSF cell count, a positive CSF Gram stain result, indicating a high number of S. pneumoniae microorganisms, is also a poor prognostic factor in patients with bacterial meningitis [12]. A more recent article on aseptic and bacterial meningitis is available. These invasive infections are serious, often require treatment in the hospital, and can lead to death. Pneumococcal meningitis | UF Health, University of Florida ... They are all caused by infection with the same bacteria, but have different symptoms. A 62-year-old Japanese man with a history of treatment for laryngeal cancer 7 years previously was transferred to the emergency department after an acute onset of delirium. By using this website, you agree to our Clinical Features of Pneumococcal Disease | CDC A chest X-ray showed an infiltrate in his left lower lung field. Most patients did not have significant comorbidities, but one had alcoholism, one had Hodgkin’s disease, and one had undergone splenectomy (present Case 1). We herein describe cases involving two adult patients with normocellular pneumococcal meningitis and present a review of eight previous cases. Pneumococcal meningitis is caused by specific bacteria: Streptococcus pneumoniae. Symptoms of pneumococcal meningitis may include stiff neck, sensitivity to light, chills, and high fever. Headache. Bacterial Meningitis in Children: Neurological ... J Med Case Reports 7, 294 (2013). Case 1 showed increased pleocytosis in the second CSF analysis, which indicated a delayed immunological response due to the lack of spleen function. The CSF was clear, and the concentrations of glucose and total protein in the CSF were 56mg/dL (blood glucose level: 92mg/dL) and 40mg/dL, respectively (Table 1). Most cases of meningitis in the United States are caused by a viral infection, but bacterial, parasitic and fungal infections are . This is the most common cause of bacterial meningitis in adults and the second most common type of meningitis in kids . Neither neck stiffness nor paralysis was apparent on physical examination. On initial physical examination, she was afebrile (36.6°C), but in a hypotensive state (88/55mmHg) with tachycardia (120 beats/minute). Meningitis is an infection of the protective membranes that surround the brain and spinal cord (meninges).

The findings in these cases indicate that the CSF can appear normal, especially when a lumbar puncture is performed soon after the start of symptoms. 2012, 73 (1): 27-30. Most cases of meningitis in the United States are caused by a viral infection, but bacterial, parasitic and fungal infections are . It causes the membranes that cover the brain and spinal cord to become inflamed. Symptoms of meningococcal disease can first appear as a flu-like illness and rapidly worsen.

It is often mild, but can cause serious symptoms, lifelong disability, or death. The most common ones include:.

2011, 183 (14): 1618-1620. Bacterial Meningitis | Johns Hopkins Medicine Suite 300 It is the second most common cause of meningitis in children older than age 2. Meningitis is an inflammation of the fluid and membranes (meninges) surrounding your brain and spinal cord. Diagnosis, Initial Management, and Prevention of Meningitis. These cases imply that a normal leukocyte count in the cerebrospinal fluid does not exclude the possibility of bacterial meningitis. Each year, approximately 1,000 people in the U . The incubation period of pneumococcal pneumonia is short, about 1 to 3 days. Pneumococcal pneumonia is the most common clinical presentation of pneumococcal disease among adults. CMAJ. It causes the membranes that cover the brain and spinal cord to become inflamed. https://doi.org/10.1186/1752-1947-7-294, DOI: https://doi.org/10.1186/1752-1947-7-294. Unusual posture, with the head and neck arched backwards ( opisthotonos) Pneumococcal meningitis is an important cause of fever in infants. Ris J, Mancebo J, Domingo P, Cadafalch J, Sanchez JM: Bacterial meningitis despite normal CSF findings. van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M: Clinical features and prognostic factors in adults with bacterial meningitis. Meningitis, Bacterial - NORD (National Organization for ... Still, many at-risk adults have not been vaccinated against pneumococcal disease. Pneumococcal meningitis: MedlinePlus Medical Encyclopedia Anyone experiencing symptoms of meningitis should see . The authors declare that they have no competing interests. Pneumococcal Meningitis: Overview and More She also stated that she had a fever of 39.7°C, which had suddenly developed after suffering chills two nights previously. A more recent article on aseptic and bacterial meningitis is available. Photophobia (eyes being more sensitive to light) Confusion. Rapid breathing. Diagnosis, Initial Management, and Prevention of Meningitis Case Rep Infect Dis. In the US, pneumococcal pneumonia causes at least 150,000 hospitalizations each year. By contrast, bacterial meningitis with a normal CSF leukocyte count has rarely been described in adults. We thank Dr Shigemi Hitomi (Department of Infectious Diseases, Tsukuba University Hospital) for his important contribution to this work. The symptoms of pneumococcal meningitis include stiff neck, fever, mental confusion and disorientation, and coma. Pneumococcal infections | NHS inform Pneumococcal meningitis is a rare but serious and life-threatening form of bacterial meningitis. Fever. Meningitis is characterized by inflammation of the membranes (meninges) around the brain or spinal cord. Weisfelt M, van de Beek D, Spanjaard L, Reitsma JB, de Gans J: Clinical features, complications, and outcome in adults with pneumococcal meningitis: a prospective case series.

Pneumococcal pneumonia (lung disease) is the most common disease caused by pneumococcal bacteria. Symptoms can include fever, cough, shortness of breath, chest pain, stiff neck, confusion, increased sensitivity to light, joint pain, chills, ear pain, sleeplessness, and irritability. Pneumococcal meningitis symptoms start suddenly, usually within 3 days of infection with . After testing, once the sensitivity of the bacteria is known, a more targeted antibiotic may be selected. Ousmane S, Kobayashi M, Seidou I, Issaka B, Sharpley S, Farrar JL, Whitney CG, Ouattara M Vaccine 2020 May 13;38(23):3922-3929. She was admitted to the intensive care unit and treated with fluid replacement and a vasopressor. Blood cultures were not obtained. Ann Neurol. 1981, 141 (10): 1369-1372. N Engl J Med. Major symptoms may include fever, headache, and a stiff neck, sometimes with aching muscles. Bacterial meningitis: Pneumococcal meningitis infections cause more than 50% of all bacterial meningitis cases in the U.S. About 8% of children and 22% of adults with pneumococcal meningitis will die. This is the most common reason for visits to a pediatrician in the U.S. 2008, 63 (1): 90-97. Coll MT, Uriz MS, Pineda V, Fontanals D, Bella F, Nava JM, Deulofeu F, Morera MA, Marti C, Lite J, Javier G, Bernat F: Meningococcal meningitis with ‘normal’ cerebrospinal fluid. The symptoms of pneumococcal pneumonia (which are similar to pneumonia caused by other organisms) include fever, cough, shortness of breath, and chest pain. There are more than 90 different strains of Streptococcus pneumoniae (S. pneumoniae) bacteria (known as serotypes), some of which cause more serious infection than others. a fever; chills She became progressively disoriented during out-patient management. Lancet Neurol. JAMA. Both patients had an acute onset of fever accompanied by neuropsychological signs and symptoms and rapid progression to septic shock. However, antibiotic resistance does occur with pneumococcal bacteria. She survived after prompt treatment, but her hearing loss remained. In babies, meningitis may cause poor eating and drinking, low alertness, and vomiting. The symptoms of pneumococcal bloodstream infection may be similar to some of the symptoms of pneumonia and meningitis, along with chills, a drop in blood pressure, and organ dysfunction severe enough to require ICU care. The death rate is higher in those age 65 years and older.

Lumbar puncture and examination of the cerebrospinal fluid (CSF) are essential steps in the diagnosis of meningitis. Complications of these ear infections can lead to . All information on this site is for general purposes only, is based on US recommendations, and is not intended to be a substitute for professional medical advice. Blood tests showed an elevated leukocyte count (27,400/μL) with a left shift, elevated C-reactive protein level (27.3mg/dL), and low platelet count (89,000/μL). 10.1056/NEJMoa040845. Case 1 was a 34-year-old Japanese woman with a history of splenectomy who presented with pyrexia, nausea, headache, and loss of hearing in her right ear.

Case 2 was a 62-year-old Japanese man with a history of laryngeal cancer who was transferred to our emergency department after an acute onset of delirium and rapid progression to septic shock. Normocellular bacterial meningitis is rarely observed in adult patients. Weisfelt et al. Springer Nature. 1994, 29 (3): 289-294. All patients with the exception of one were younger than 65 years, and seven were male. Diagnosis, Initial Management, and Prevention of Meningitis. There are three major conditions caused by invasive pneumococcal disease: pneumonia, bacteremia, and meningitis. Within 1 hour of arrival, he developed hypotension and subsequent cardiopulmonary arrest, and resuscitation was unsuccessful. Bethesda, MD 20814 Meningitis can be caused by a bacterial, fungal or viral infection. In adult patients with bacterial meningitis, a low white blood cell count in the CSF is an important risk factor for a poor prognosis [10]. CSF examination on day 2 of hospitalization showed marked pleocytosis (mononuclear cells: 2448/μL, polymorphonuclear cells: 1638/μL), an increased total protein level (270mg/dL), and a decreased glucose level (13mg/dL). Pneumococcal meningitis is caused by Streptococcus pneumoniae bacteria (also called pneumococcus, or S pneumoniae).This type of bacteria is the most common cause of bacterial meningitis in adults. The drug susceptibilities of S. pneumoniae grown in the CSF cultures were determined by the disk dilution method and showed susceptibility to penicillin (≥20mm), erythromycin (≥21mm), and levofloxacin (≥17mm). Fishbein DB, Palmer DL, Porter KM, Reed WP: Bacterial meningitis in the absence of CSF pleocytosis. Meningitis is an infection of the membranes (meninges) surrounding the brain and spinal cord. YK and MS were involved in the clinical diagnostic evaluation and management. Cite this article. Two blood samples for culture were obtained simultaneously with the start of intravenous antimicrobial therapy in the emergency department, but no bacteria were cultivated. Even with treatment, 20 percent of people with this type of infection die. A 34-year-old Japanese woman presented to our hospital one morning because of nausea, headache, and loss of hearing in her right ear, all of which had developed a few hours before visiting our hospital. This means they can occur with any pneumococcal infection. Terms and Conditions, People with bacterial meningitis can have seizures, go into a coma, and even die. In some cases, the symptoms may develop sooner or later than that. Arch Intern Med. The symptoms of a pneumococcal infection can vary, depending on . © 2021 BioMed Central Ltd unless otherwise stated. The swelling from meningitis typically triggers signs and symptoms such as headache, fever and a stiff neck. Pneumococcal meningitis symptoms start suddenly, usually within 3 days of infection with . White K, Ostrowski K, Maloney S, Norton R: The utility of cerebrospinal fluid parameters in the early microbiological assessment of meningitis. Diagnosis is by Gram stain and culture. Montassier E, Trewick D, Batard E, Potel G: Streptococcus pneumoniae meningitis in an adult with normal cerebrospinal fluid.

Of the 10 patients (Table 2), four had negative findings on the initial Gram stains, and all of these patients survived. 10.1016/j.diagmicrobio.2012.02.010. Her hearing loss remained. The most common symptoms are a stiff neck, high fever, sensitivity to light, confusion, headaches and vomiting. As in Case 1, cerebrospinal fluid examination showed a normal leukocyte count despite the presence of S. pneumoniae, which was detectable with Gram staining. Part of Pneumococcal meningitis is the most common form of meningitis and is the most serious form of bacterial meningitis. The symptoms of bacterial meningitis are high fever, headache, and stiff neck in anyone over the age of 2 years. PubMed  301.656.0003, 1629 K Street, NW When these bacteria invade the lungs, they can cause pneumonia; when they invade the bloodstream, they can cause sepsis; and when they invade the covering of the brain, they can cause meningitis. Pneumococcal meningitis is the most common form of meningitis and is the most serious form of bacterial meningitis. She had a history of splenectomy as a result of a traffic accident, but had not received a pneumococcal vaccine. She was in a hypotensive state with no neck stiffness and had a normal mental status at the initial presentation. Headache. Fewer people will get pneumococcal meningitis or bloodstream infection, but the mortality rate for these infections is higher, even with proper treatment. Decreased consciousness. PubMed  HS, HN, and YT analyzed and interpreted the patient data and were major contributors in writing the first draft.

10.1002/ana.21216. Photophobia (eyes being more sensitive to light) Confusion. There was no obvious deficiency in her mental status nor was neck stiffness detected at initial presentation, but she became progressively disoriented (Glasgow coma scale rating of E3V4M6) during out-patient management. California Privacy Statement, Most cases of meningitis in the United States are caused by a viral infection, but bacterial . It can cause life-threatening blood poisoning (septicaemia) and result in permanent . This is the most common cause of bacterial meningitis in adults and the second most common type of meningitis in kids . About 1 in 20 individuals who get pneumococcal pneumonia will die. Correspondence to Pneumococcal pneumonia is the most common clinical presentation of pneumococcal disease among adults. Gram staining of cerebrospinal fluid and immediate administration of antibiotics should be performed in all patients with suspected bacterial meningitis. Symptoms of Pneumococcal Meningitis People typically develop symptoms one to three days after they were exposed to the bacteria. This article is published under license to BioMed Central Ltd. Pneumococcal meningitis is caused by specific bacteria: Streptococcus pneumoniae. 1994, 32 (4): 265-268. 1985, 254 (20): 2893-2894. Symptoms of Pneumococcal Meningitis People typically develop symptoms one to three days after they were exposed to the bacteria. Blood tests revealed a low leukocyte count (2480/μL), elevated C-reactive protein level (33.0mg/dL), and low platelet count (38,000/μL). She had received oral cephalosporin (cefditoren pivoxil) and an antipyretic analgesic (loxoprofen sodium hydrate), which were prescribed at a nearby clinic, for the fever on the day before her hospital visit. By contrast, four of five patients with Gram-positive cocci observed on the initial Gram stains died after rapid progression of the clinical course [4, 6], and the only survivor (Case 1 in this report) had persistent hearing loss. On This Page. Ousmane S, Kobayashi M, Seidou I, Issaka B, Sharpley S, Farrar JL, Whitney CG, Ouattara M Vaccine 2020 May 13;38(23):3922-3929.

2012, 2012: 508503-, PubMed  Pneumococcal Infections. He had developed a fever the previous day. Some 6,000 cases of pneumococcal meningitis are reported in the United States each year. Hiromichi Suzuki. The difference was attributed to recovery of transient hearing impairment . In babies, meningitis may cause poor eating and drinking, low alertness, and vomiting. Symptoms can include headache and fever for up to 5 days, followed by personality and behavioral changes, seizures, hallucinations, and . Children younger than 2 years old are among those most at risk for the disease. The most common ones include:. Google Scholar. In some cases, the symptoms may develop sooner or later than that. The symptoms of a pneumococcal infection can vary, depending on . Some 6,000 cases of pneumococcal meningitis are reported in the United States each year. Even with treatment, 20 percent of people with this type of infection die. Pneumococcal meningitis is a rare but serious and life-threatening form of bacterial meningitis.

Examination of a CSF sample obtained 90 minutes after presenting to the hospital demonstrated a normal cell count (2/μL) without red blood cells. Vaccines are recommended for all children and for certain adults–those age 65 years and older, and adults age 19 to 64 years with certain risk conditions. While vaccines against meningococcal disease have been available for more than 40 . This approach is important because the CSF cell count may not be elevated in the first CSF examination, and the presence of Gram-positive cocci in the CSF is associated with high mortality and morbidity in patients with normocellular pneumococcal meningitis. Nagai K, Gotoh K, Hirotaki S, Hidaka H, Koga H, Ikenaga M, Masunaga K, Tsumura N, Hashimoto K: A case of bacterial meningitis due to Streptococcus bovis in an infant with normal cerebrospinal fluid findings at the first CSF examination. The absence of pleocytosis in the CSF has occasionally been described in cases of pediatric meningitis [2, 3], especially in the very acute phase of bacterial meningitis [2]. Although the patient described in Case 2 died of pneumococcal meningitis, the hospital ethics committee confirmed that written informed consent could be waived because the family agreed to the anonymous use of the patient’s data for clinical research purposes. She recovered after a 3-week treatment with these antimicrobial agents and was discharged on day 23. About 1 in 12 children and 1 in 7 older adults who get pneumococcal . To the best of our knowledge, only eight cases of adult patients with pneumococcal meningitis with a normal CSF cell count have been previously reported [4–9]. Middle ear infections. Other symptoms that can occur with this disease: Agitation. Bacterial meningitis: Pneumococcal meningitis infections cause more than 50% of all bacterial meningitis cases in the U.S. About 8% of children and 22% of adults with pneumococcal meningitis will die. The two most common types of meningococcal infections are meningitis and septicemia. In both cases in this report, CSF examinations showed normal leukocyte counts despite the presence of S. pneumoniae, which was detectable with Gram staining. It can affect anyone, but is most common in babies, young children, teenagers and young adults. When the membranes become infected, they swell and press on the spinal cord or brain. Suzuki, H., Tokuda, Y., Kurihara, Y. et al. Meningococcal meningitis is a rare but serious bacterial infection. Gram staining of the CSF showed numerous Gram-positive cocci that were proven to be S. pneumoniae by CSF culture. Pneumococcal disease is a leading cause of serious illness throughout the world. PubMed Central  Symptoms can include headache and fever for up to 5 days, followed by personality and behavioral changes, seizures, hallucinations, and . Meningitis can be very serious if not treated quickly. Eur Neurol. volume 7, Article number: 294 (2013) PubMed Google Scholar. PubMed  This website is designed to provide education to the public and healthcare professionals about the burden, causes, prevention, diagnosis, and treatment of infectious diseases across the lifespan. . Typically, symptoms of bacterial meningitis develop within 3 to 7 days after exposure; note, this is not true for TB meningitis, which can develop much later after exposure to the bacteria. This can cause life-threatening problems. Ethiop Med J. The bacteria can also cause milder common conditions like middle-ear infection (otitis media) and sinusitis. A cerebrospinal fluid examination showed a normal leukocyte count despite the presence of Streptococcus pneumoniae, which was detectable with Gram staining. The clinical characteristics of the previous and current cases are summarized in Table 2. Weisfelt M, van de Beek D, Spanjaard L, Reitsma JB, de Gans J: A risk score for unfavorable outcome in adults with bacterial meningitis. Pneumococcal infections are caused by the Streptococcus pneumoniae bacteria, and range from mild to severe. 10.1001/archinte.1981.00340100125027. PubMed Central  Brain and spinal cord tissue (meningitis) Blood (bacteremia) Symptoms of pneumococcal infection depend on the part of the body affected. There are more than 90 different strains of Streptococcus pneumoniae (S. pneumoniae) bacteria (known as serotypes), some of which cause more serious infection than others. Poor feeding or irritability in children. http://creativecommons.org/licenses/by/2.0. Diagn Microbiol Infect Dis. Manage cookies/Do not sell my data we use in the preference centre. Other symptoms that can occur with this disease: Agitation. 10.1016/S1474-4422(05)70288-X. Meningococcal meningitis is a rare but serious bacterial infection. The signs and symptoms of pneumococcal disease may be non-specific. This is the most common reason for visits to a pediatrician in the U.S. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Characterization of pneumococcal meningitis before and after introduction of 13-valent pneumococcal conjugate vaccine in Niger, 2010-2018. Streptococcus pneumoniae (pneumococci) are gram-positive, alpha-hemolytic, aerobic, encapsulated diplococci. Characterization of pneumococcal meningitis before and after introduction of 13-valent pneumococcal conjugate vaccine in Niger, 2010-2018. Meningitis is an infection of the membranes (meninges) that protect the spinal cord and brain. Google Scholar, Alvarez EF, Olarte KE, Ramesh MS: Purpura Fulminans secondary to Streptococcus pneumoniae Meningitis. Case 1 was a 34-year-old Japanese woman with a history of splenectomy who presented with pyrexia, nausea, headache, and loss of hearing in her right ear. Symptoms of pneumococcal meningitis may include stiff neck, sensitivity to light, chills, and high fever. Pneumococcal meningitis is a type of bacterial meningitis, a serious infection of the meninges, membranes that surround the brain and spinal cord. Unusual posture, with the head and neck arched backwards ( opisthotonos) Pneumococcal meningitis is an important cause of fever in infants. a fever; chills Adult pneumococcal meningitis presenting with normocellular cerebrospinal fluid: two case reports. Symptoms generally include an abrupt onset of fever and chills or rigors. The swelling from meningitis typically triggers symptoms such as headache, fever and a stiff neck. The present and previous cases suggest that bacterial meningitis should be considered in adult patients suspected to have bacterial meningitis, even if the initial CSF cell count is normal, and that Gram staining of the CSF and prompt administration of an adequate dose of antibiotics should be performed with a second CSF examination the following day.

The symptoms of pneumococcal bloodstream infection may be similar to some of the symptoms of pneumonia and meningitis, along with chills, a drop in blood pressure, and organ dysfunction severe enough to require ICU care. Privacy DAVID M. BAMBERGER, MD, University of Missouri-Kansas City . J Infect.

2008, 82 (1): 26-29. Article  Meningitis is an inflammation of the membranes (meninges) surrounding your brain and spinal cord. Typically, the CSF shows significant neutrophilic pleocytosis [1], a decreased glucose concentration, and an elevated protein level. Fever. Symptoms of pneumococcal meningitis, an infection of the lining of the brain and spinal cord, include: Stiff neck. 10.1503/cmaj.090310. Symptoms can include fever, cough, shortness of breath, chest pain, stiff neck, confusion, increased sensitivity to light, joint pain, chills, ear pain, sleeplessness, and irritability. Pneumococcal disease is caused by common bacteria (Streptococcus pneumoniae) that can attack different parts of the body.

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