Bacalhau Sílvia, Zarcos Maria Manuel, Rezende Teresa
Serviço de Pediatria, Hospital Santo André, Leiria, Portugal.
Acta Med Port. 2011 Dec;24 Suppl 3:627-30. Epub 2011 Dec 31.
Meningitis is an uncommon clinical manifestation of invasive infection by Streptococcus pyogenes.
A four years-old female child, previously healthy, started a history of high fever, associated to right otorrhea, prostration and vomiting. On admission she was haemodynamically stable but prostrated, with stiff neck and right otorrhea. Laboratory evaluation showed leukocytosis with neutrophilia, thrombocytosis and high C-reactive protein. The cerebrospinal fluid (CSF) examination suggested bacterial meningitis and treatment with ceftriaxone was started. After Streptococcus pyogenes grew in the CSF, clindamycin was added. She completed 15 days of antibiotics and was discharged clinically recovered. No neurological or hearing sequelae were observed.
Although the incidence of group A streptococcal meningitis seems to be low, invasive infection by this agent is raising. Despite the excellent evolution of this case, a fatal outcome or neurological sequelae can arise, even in healthy children.
脑膜炎是化脓性链球菌侵袭性感染的一种不常见临床表现。
一名4岁女童,既往健康,开始出现高热病史,伴有右耳流脓、精神萎靡和呕吐。入院时她血流动力学稳定但精神萎靡,有颈强直和右耳流脓。实验室检查显示白细胞增多伴中性粒细胞增多、血小板增多和高C反应蛋白。脑脊液(CSF)检查提示细菌性脑膜炎,开始用头孢曲松治疗。脑脊液中培养出化脓性链球菌后,加用克林霉素。她完成了15天的抗生素治疗,临床康复出院。未观察到神经或听力后遗症。
虽然A组链球菌脑膜炎的发病率似乎较低,但该病原体的侵袭性感染正在增加。尽管该病例预后良好,但即使是健康儿童也可能出现致命后果或神经后遗症。