Recovery of a Patient With Type Iii Pneumococcus Meningitis of Otitic Origin

Abstract

Type III pneumococcus meningitis is a disease so uniformly fatal that it appears of particular interest to report a complete recovery. B. B., a boy aged 5\m=1/2\years, was first admitted to the hospital on Oct. 9, 1937. The mother stated that two weeks previously the child had complained of pain in the right ear, for which ear drops were given and the child put to bed. The pain subsided in three days, and the patient was well thereafter until three days before his admission, when he again complained of pain in the right ear. The pain was accompanied by malaise. The temperature was 103 F. Tenderness and swelling were present behind the right ear.On admission there was tenderness over the right mastoid, which was more marked over the zygomatic region. There was postauricular swelling, with displacement of the auricle and sagging of the superoposterior canal wall. There was a mucopurulent discharge from the external auditory canal. The temperature was 103.6 F. The leukocyte count was 19,000, with 90 per cent of polymorphonuclear cells. The urine was normal. Immediate mastoidectomy was advised. It was performed the same afternoon. A postauricular incision was made extending down to the periosteum. As soon as the periosteum over the antrum was elevated, a gret deal of pus welled up through a perforated cortex. The lesion in the cortex extended forward toward the zygoma. The cells were filled with pus, but the intercellular structure was not destroyed. The tegmen antri was soft, and was removed. The dura was normal in appearance. Culture of pus from the mastoid yielded Pneumococcus type III.The postoperative course was uneventful. Four days after the operation the sutures were removed; the mastoid wound was clean. From October 14 the patient was afebrile, and he was discharged apparently well on October 19, ten days after admission.The day after his discharge the child had a frontal and occipital headache and vomited. The next day (October 21) he appeared comfortable and did not complain, although he had a congested pharynx, subacute tonsillitis and an inflammation of the left ear. Two days later the mastoid wound was dressed and was found to be clean. On October 24 he again complained of severe frontal headache, and finally, on October 25, he was readmitted to the hospital acutely ill. The temperature was 102.4, and he complained of severe frontal headache.From the Oto-Laryngologic Service of the Israel-Zion Hospital, Samuel J. Kopetzky, M.D., director.

Treatment of Meningitis Due to Pneumococcus Type Iii With Sulfanilamide; Recovery

“…During the first twenty-four hours the patient was given 9.3 Gm. of sulfanilamide ; the next day, 8 Gm. ; the third day, 4 Gm.…”

“…She was treated for diabetic acidosis, and the next morning (September 21) the sugar content of the blood was 67 mg. per hundred cubic centimeters and the carbon dioxide-combining power 70 volumes per cent. She was given sulfanilamide, 8 Gm. the first day, 6 Gm.…”