“…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.…”