Varicella is usually self-limiting but occasionally severe infectious disease (with 2 to 6% of cases resulting in complications). The aim was to report a case with hemorrhagic-necrotic rash, discrete cerebellar ataxia and immune suppression. A two-year-and-seven-month-old boy with fever, tonsillitis and rose-colored-spots rash was treated with Amoxiclav and antihistamines followed by improvement. Eight days after treatment, fever, vesiculous rash (consequently hemorrhagicnecrotic) and enlarged lymph nodes appeared. On admission, the child was in severe condition, with generalized polymorph rash (vesicles with bloody content on necrotic surface, few crusts), generalized enlarged and painful lymph nodes, increased breath and heart rates, hepatosplenomegaly, depressed patellar and Achilles reflexes, positive Babinski sign; without signs of meningeal irritation. Ataxia had observed and Romberg was positive. Laboratory investigations revealed anemia, thrombocytopenia and normal humoral immunity. Lymphopenia (12.28%), decreased total Т-lymphocytes, normal CD4+/ CD8+ T-lymphocytes ratio at normal CD4+ and decreased CD8+ Т cells, increased В-lymphocytes were found by flow-cytometry. Serological investigations (ELISA) revealed significant titers of specific IgM antibodies against three different herpesviruses (HSV-1, HSV-2 and Varicella zoster virus). Complex etiologic and supportive treatment was administered. The child had improved after sixth day and was discharged on eleventh day. Hemorrhagic-necrotic form of varicella is rare. It occurs mainly in immunocompromised patients, but immunocompetent individuals also could be affected. This requires the use of broad diagnostic panel for precise etiological diagnosis, which will facilitate the proper treatment and favorable outcome.
Meningitis/ meningoencephalitis due to Streptococcus pneumoniae are with severe course and high mortality rate. A case of severe meningoencephalitis by S. pneumoniae secondary to chronic bilateral otitis and mastoiditis is presented here. A 37-year-old male patient was admitted with fever, excitation, somnolence and meningeal irritation. Investigation of cerebrospinal fluid (CSF) revealed increased protein level (11.3 g/L), leucocytes count 59,790/μL (93% neutrophils), extremely decreased glucose level (0.1 mmol/L). S. pneumoniae was confirmed by latex test and culture of CSF. Otitis media and mastoiditis were found bilaterally by computerized tomography. Bilateral cortical mastoidectomy was performed together with antibacterial treatment by consequently ceftazidime and cefepime and corticosteroids were administered. He experienced progressive improvement and was discharged with normal laboratory parameters and without sequels after 17 days hospital treatment. In conclusion, both surgical and conservative treatments are crucial for outcome of meningitis/ meningoencephalitis by S. pneumoniae secondary to chronic mastoiditis. J Microbiol Infect Dis 2013; 3(2): 86-88Key words: Streptococcus pneumoniae, meningitis, meningoencephalitis, mastoiditis Streptococcus pneumonia'nin sebep olduğu otojenik meningoensefalit ÖZETStreptococcus pneumoniae'nın sebep olduğu menenjit/meningoensefalitler ağır bir seyrederler ve yüksek mortalite gös-terirler. Burada kronik bilateral otitis media ve mastoidite seconder olarak gelişen ciddi seyirli bir S. pneumoniae olgusu sunuldu. Otuz yedi yaşında erkek hasta ateş, eksitasyon, somnolans ve menings irritasyon bulguları ile başvurdu. Beyin omurilik sıvısı (BOS) incelemesinde artmış protein seviyesi (11,3 g/L), lökosit sayısı µL'de 59790 (%93'ü nötrofil) ve çok düşük düzeyde glukoz düzeyi (0,1 mmol/L) bulundu. S. pneumoniae'nın etken olduğu BOS'tan yapılan lateks testi ve kültürle doğrulandı. Bilgisayarlı tomografi ile bilateral otitis media ve mastoidit olduğu gösterildi. Seftazidim ve devamında sefepim ve şeklinde antibakteriyel tedavi, destek tedavisi ve kortikosteroid uygulaması yanında bilateral kortikal mastoidektomi yapıldı. Hasta hızlı bir iyileşme gösterdi ve hastanede 17 gün süren bir tedaviden sonra normal klinik ve laboratuvar bulgularla taburcu edildi. Sonuç olarak hem cerrahi hem de konservatif tedavi kronik mastoidite sekonder olan ve S. pneumoniae'nın etken olduğu menenjit/ meningoensefalitlerde akıbet için hayati önem taşırlar.
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