Ahmed S, Biswas T, Paul S P
Dr Shameem Ahmed, Senior Consultant Neurosurgeon, Department of Neurosurgery, Apollo Hospitals (Unit: International Hospital), Guwahati , India.
Mymensingh Med J. 2018 Oct;27(4):898-903.
Staphylococcus aureus is a global bacterial pathogen. It is an uncommon pathogen causing central nervous system infections, accounting for <1% cases of bacterial meningitis. Sinusitis, trauma and presence of an intracranial device have been reported as risk factors for developing meningitis and brain abscesses. A previously healthy 5-month-old female infant presented to a hospital in North-Eastern India in February 2018 with Staphylococcus aureus sepsis and meningitis and was subsequently detected to have developed bilateral subdural empyema on computed tomography scan of the brain. Burr hole evacuation procedure of subdural empyema was done on day-18 subsequent to which inflammatory markers and temperature gradually normalized. Prolonged course of intravenous antibiotics (5-weeks) and anticonvulsants were needed. This case highlights the importance of considering brain abscess and empyema in a child with meningitis whose temperature do not settle down after being treated appropriately and adequately with intravenous antibiotics and features such as seizures develop. It also reflects the challenges that may be faced by clinicians in resource-limited settings both during acute and follow-up stages.
金黄色葡萄球菌是一种全球性的细菌病原体。它是引起中枢神经系统感染的罕见病原体，占细菌性脑膜炎病例的不到1%。鼻窦炎、外伤和颅内装置的存在已被报道为发生脑膜炎和脑脓肿的危险因素。一名此前健康的5个月大女婴于2018年2月在印度东北部的一家医院就诊，患有金黄色葡萄球菌败血症和脑膜炎，随后在脑部计算机断层扫描中被检测出双侧硬膜下积脓。在第18天进行了硬膜下积脓钻孔引流手术，此后炎症标志物和体温逐渐恢复正常。需要长期静脉使用抗生素（5周）和抗惊厥药物。该病例强调了对于患有脑膜炎且在接受适当且充分的静脉抗生素治疗后体温未恢复正常以及出现癫痫发作等症状的儿童，考虑脑脓肿和积脓的重要性。它还反映了资源有限环境中的临床医生在急性期和随访阶段可能面临的挑战。
