Polymicrobial Bacterial Meningitis in a Patient with Chronic Suppurative Otitis Media: Case Report and Literature Review

Abstract

Polymicrobial meningitis is a rare entity in the adult population, especially in the antibiotic era. However, disorders such as chronic suppurative otitis media (CSOM) or even poor oral hygiene are considered risk factors for the development of such cerebral infection. We report a case of polymicrobial meningitis associated with oto-mastoiditis in a 64-year-old female patient known to have CSOM. The patient presented atypical symptoms for community-acquired meningitis, showing subacute evolution of headache, without fever or neck stiffness. The aerobe microorganisms Streptococcus anginosus and Corynebacterium spp., sensitive to beta-lactamines, and the anaerobe Prevotella spp., resistant to penicillin and metronidazole, were isolated from CSF specimens, while Proteus mirabilis and Enterococcus faecalis were identified from the ear drainage. The diversity of pathogens identified in our case led us to the hypothesis of two different sources of meningitis: otogenic and/or odontogenic. Favorable evolution was obtained after a multi-disciplinary approach, combining surgery and broad-spectrum antibiotics. In addition, we performed a literature review that highlights the low incidence of polymicrobial mixed aerobe–anaerobe meningitis.

Unveiling the Dental Connection: A Case Report of Odontogenic Initiating Chronic Suppurative Otitis Media

“…While prior reports have hinted at a modest association between ear infections and dental caries, this case offers additional evidence to substantiate such a connection, emphasizing the need for further investigation in this area. (Morris, 2012;Vâţă et al, 2023) Furthermore, it underscores the importance of considering nonotological factors when dealing with unresolved cases characterized by atypical disease trajectories or unclear etiologies. Ultimately, this case serves as a poignant reminder of the significance of adopting a comprehensive, patient-centered approach and maintaining a broad differential when addressing complex and persistent medical conditions.…”

“…Patients with this condition often experience acquired hearing loss, which, if left untreated, can result in further health complications and potential mortality. (Mittal et al, 2015;Vâţă et al, 2023) Dental caries is a term encompassing both the disease itself and the resulting dental lesion. The caries process primarily takes place within the biofilm, which remains perpetually active and responsive to pH fluctuations.…”