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

Abstract

Acute meningitis is one of the most dramatic of all the infections of the nervous system in its sudden onset and rapid progress. Except for meningitides due to the meningococcus and a few other agents, the outlook for the preservation of life is usually poor. The prognosis is particularly unfavorable for pneumococcic meningitis, and a fatal termination has almost invariably occurred. In this paper a case of meningitis due to the type III pneumococcus in which recovery, presumably due to sulfanilamide therapy, occurred is reported. The patient remained well four months after recovery and then died of a disease related to hypertension. The experience at the Philadelphia General Hospital with meningitis due to Pneumococcus type III is reviewed, as are certain aspects of the literature. REPORT OF A CASEB. M., a 47 year old Negress, was admitted to the Philadelphia General Hospital, service of Dr. J. C. Yaskin, on May 8, 1938. She had been brought by a friend, who had found her in a generalized clonic convulsion, which was followed by wild, purposeless movements. The patient was delirious on admission, did not recognize her friends and apparently could not speak. The history obtained later from her relatives revealed that nine days before admission she had had a "cold," followed by pain in the right ear. A discharge of pus from the right ear had been noticed on May 5. Disturbances of consciousness and convulsions had not appeared until the day of admission.In 1925 and 1926 she had received a full course of antisyphilitic therapy.Since 1932 she had been admitted to the hospital on three different occasions for diabetic acidosis. There was a history of chronic alcoholism and of intermittent trouble with the ears.On admission the patient was restless and did not respond effectively to stimuli. She was moderately well nourished, although obviously acutely ill and febrile. She flung her arms and legs about purposelessly. Her blood pressure was 230 systolic and 166 diastolic, and her heart was enlarged to the left. There was a purulent discharge from the right ear. Nuchal rigidity was marked, and the Kernig and Brudzinski signs were present. The tendon reflexes were all active. During the examination right-sided jacksonian convulsions were noted. There was no Babinski sign. A spinal tap done at this time released cloudy fluid, the pressure of which was 10 mm. of mercury.The spinal fluid on May 8 contained 2,100 cells, of which 95 per cent were polymorphonuclear, and a pure culture of Pneumococcus type III was grown. The Wassermann reaction of the spinal fluid was negative. Examinations of the blood yielded the following data: sugar content, 244 mg. per hundred cubic centimeters; carbon dioxide-combining power, 44 volumes per cent; urea nitrogen From the Philadelphia