Childhood meningitis caused by enterococci and viridans streptococci

Abstract

Selected clinical and laboratory parameters were studied respectively in patients with meningitis caused by enterococci and viridans streptococci in an academic children's hospital. During a nine-year period (1981-1989), enterococci or viridans streptococci were isolated from the cerobrospinal fluid (CSF) of 48 patients. In nine of these 48 patients, enterococci or viridans streptococci were the causative agents of meningitis. These nine children constituted 2.0% of 450 patients with bacterial meningitis in this period. All nine children suffered from underlying diseases; neurosurgical procedures were performed in six of these patients, of whom four had ventricular drains. A head trauma preceded the development of meningitis in another patient. Drainage of the lacrimal duct was associated with the development of meningitis in another patients. One child concurrently suffered from severe gastroenteritis. CSF leukocyte count and CSF protein levels were moderately elevated, whereas CSF glucose levels were either slightly decreased or within the normal range. Meningitis due to enterococci or viridans streptococci is seen predominantly in children under the age of one year. Predisposing factors, including neurosurgical procedures, head trauma and severe gastroenteritis, are usually present in these patients. The prognosis for recovery is generally good.

Adults with Meningitis Caused by Viridans Streptococci

“…However, their presence may be associated with subacute bacterial endocarditis, especially in patients with abnormal or prosthetic heart valves. Typically, most patients with meningitis caused by viridans streptococci reveal a high incidence of underlying conditions, including bacterial endocarditis, head trauma or neurosurgical procedures, gastroenteritis, sinusitis or otitis media [3,6,11]. Although post-traumatic and /or postneurosurgical states and medical procedures appear to be important portals of entry in other studies [3,11], most of our patients had otopharyngeal infection and hematogenous spread as underlying conditions.…”

“…With the exceptions of S. pneumoniae meningitis in both children and adults [1] and Streptococcus agalactiae (group B streptococci) meningitis in neonates [2], other streptococci are not common as causative pathogens for meningitis in adults and children [1][2][3][4][5][6][7][8][9][10].Viridans streptococci, normally inhabiting of the oral cavity, gastrointestinal tract, female genital tract and upper respiratory tract, are often considered to be contaminants when isolated from blood culture. During a period of 15 years, we identified 12 adult patients with meningitis caused by viridans streptococci in our hospital.…”

Meningitis due to viridans streptococci in adults

“…In The Netherlands, viridans streptococci were isolated in 0.1% of children, and 2.8% of adults with bacterial meningitis in 1993 and 1994 [8,9]. In a retrospective series of childhood meningitis in The Netherlands, 1.0% of cases was caused by viridans streptococci [6]. One retrospective hospital-based review from California on adult patients with bacterial meningitis reported a prevalence of 6/86 (7.0%) [3].…”

Enterococcal Meningitis with Bilateral Subdural Effusion in a Healthy Young Infant

“…Stevenson and colleagues found only four cases of enterococal meningitis among 493 episodes of bacterial meningitis in adults [2]. Another study by Koorevaar et al [3] of 450 episodes of bacterial meningitis in children over a nine year period (1981)(1982)(1983)(1984)(1985)(1986)(1987)(1988)(1989), either enterococci or streptococcus viridans together accounted for only nine cases. All these patients had predisposing factors.…”