Okada Taiji, Yoshitomi Hiroyuki, Harada Yuji, Ito Shimpei, Nakamura Taku, Adachi Tomoko, Nakashima Ryuma, Sugamori Takashi, Endo Akihiro, Takahashi Nobuyuki, Tanabe Kazuaki
Division of Cardiology, Shimane University Faculty of Medicine, Shimane-ken, Japan.
Clinical Laboratory Department, Shimane University Faculty of Medicine, Shimane-ken, Japan.
J Cardiol Cases. 2014 Dec 19;11(3):96-99. doi: 10.1016/j.jccase.2014.11.005. eCollection 2015 Mar.
is the most common cause of community-acquired bacterial meningitis in adults. Pneumococcal endocarditis coexisting with meningitis is rare, especially in healthy individuals. A 66-year-old woman was admitted with pneumococcal bacteremia, meningitis, and arthritis. She was in good condition before admission. Because of typical presentation of bacterial meningitis characteristics and normal echocardiographic findings, the patient was administered antibiotics for meningitis and arthritis. On hospitalization day 59, she developed a fever, and echocardiography showed severe aortic regurgitation, perforation, and vegetation of the aortic valve. She was diagnosed with pneumococcal endocarditis and underwent aortic valve replacement surgery. In general, invasive pneumococcal infections occur in debilitated middle-aged men with predisposing factors such as chronic alcoholism, chronic obstructive pulmonary disease, and immunosuppressive conditions. In this case, regardless of the appropriate treatment and no risk of invasive pneumococcal infections, infective endocarditis occurred. < This case suggested that invasive pneumococcal infections progressing to infective endocarditis can occur in healthy individuals and underscore the importance of careful observation in patients with pneumococcal meningitis, in particular, in the case of blood culture positive patients.>.
是成人社区获得性细菌性脑膜炎最常见的病因。肺炎球菌性心内膜炎合并脑膜炎较为罕见,尤其是在健康个体中。一名66岁女性因肺炎球菌菌血症、脑膜炎和关节炎入院。入院前她状况良好。由于具有典型的细菌性脑膜炎特征表现且超声心动图检查结果正常,该患者接受了针对脑膜炎和关节炎的抗生素治疗。在住院第59天,她出现发热,超声心动图显示严重主动脉瓣反流、穿孔及主动脉瓣赘生物。她被诊断为肺炎球菌性心内膜炎并接受了主动脉瓣置换手术。一般来说,侵袭性肺炎球菌感染发生在有慢性酒精中毒、慢性阻塞性肺疾病和免疫抑制状态等易感因素的体弱中年男性中。在本病例中,尽管进行了适当治疗且无侵袭性肺炎球菌感染风险,但仍发生了感染性心内膜炎。<该病例提示,侵袭性肺炎球菌感染进展为感染性心内膜炎可发生在健康个体中,并强调了对肺炎球菌性脑膜炎患者,尤其是血培养阳性患者进行仔细观察的重要性。>