2nd Department of Lung Diseases and Tuberculosis, Medical University of Bialystok, Żurawia 14, 15-540, Białystok, Poland.
Department of Infectious Diseases and Neuroinfections, Medical University of Białystok, Żurawia 14, 15-540, Białystok, Poland.
BMC Infect Dis. 2022 Feb 23;22(1):182. doi: 10.1186/s12879-022-07156-1.
SARS-CoV-2 is the major cause of infections in humans since December 2019 and is top of the global health concern currently. Streptococcus pneumoniae is one of the leading pathogens of invasive bacterial diseases, including pneumonia, sepsis, and meningitis. Moreover, this bacteria is mostly responsible for secondary infections subsequent to post-viral respiratory disease. Co-infections with bacterial and viral pathogens are associated with severe course of the disease and are a major cause of mortality. In this report, we describe a rare case of COVID-19 patient with pneumococcal sepsis and meningitis of unsuccessful course.
A 89-year-old man, not vaccinated against SARS-CoV-2 infection, was diagnosed with COVID-19 pneumonia. Patient required oxygen therapy due to respiratory failure. The initial treatment of viral infection with tocilizumab and dexamethasone allowed for the stabilization of the patient's condition and improvement of laboratory parameters. On the 9th day of hospitalization the patient's condition deteriorated. Consciousness disorders and acute respiratory disorders requiring intubation and mechanical ventilation were observed. Brain computed tomography excluded intracranial bleeding. The Streptococcus pneumoniae sepsis with concomitant pneumoniae and meningitis was diagnosed based on microbiological culture of blood, bronchial wash, and cerebrospinal fluid examination. Despite targeted antibiotic therapy with ceftriaxone and multidisciplinary treatment, symptoms of multiple organ failure increased. On the 13th day of hospitalization, the patient died.
Co-infections with bacterial pathogens appear to be not common among COVID-19 patients, but may cause a sudden deterioration of the general condition. Not only vascular neurological complications, but also meningitis should be always considered in patients with sudden disturbances of consciousness. Anti-inflammatory treatment with the combination of corticosteroids and tocilizumab (or tocilizumab alone) pose a severe risk for secondary lethal bacterial or fungal infections. Thus, treating a high-risk population (i.e. elderly and old patients) with these anti-inflammatory agents, require daily clinical assessment, regular monitoring of C-reactive protein and procalcitonin, as well as standard culture of blood, urine and sputum in order to detect concomitant infections, as rapidly as possible.
自 2019 年 12 月以来，SARS-CoV-2 是导致人类感染的主要原因，目前是全球健康关注的焦点。肺炎链球菌是导致侵袭性细菌性疾病的主要病原体之一，包括肺炎、败血症和脑膜炎。此外，这种细菌主要负责病毒性呼吸道疾病后的继发感染。细菌和病毒病原体的合并感染与疾病的严重程度有关，是导致死亡率的主要原因。在本报告中，我们描述了一例 COVID-19 患者并发肺炎链球菌败血症和脑膜炎且治疗效果不佳的罕见病例。
一名 89 岁男性，未接种 SARS-CoV-2 疫苗，被诊断为 COVID-19 肺炎。由于呼吸衰竭，患者需要吸氧治疗。使用托珠单抗和地塞米松治疗病毒感染初始阶段使患者病情稳定，实验室参数改善。住院第 9 天，患者病情恶化。观察到意识障碍和急性呼吸障碍，需要插管和机械通气。脑计算机断层扫描排除了颅内出血。根据血、支气管灌洗液和脑脊液检查的微生物培养，诊断为肺炎链球菌败血症伴肺炎和脑膜炎。尽管使用头孢曲松进行靶向抗生素治疗和多学科治疗，但多器官衰竭症状增加。住院第 13 天，患者死亡。
在 COVID-19 患者中，细菌病原体的合并感染似乎并不常见，但可能导致病情突然恶化。在意识突然紊乱的患者中，不仅要考虑血管神经系统并发症，还要考虑脑膜炎。皮质类固醇和托珠单抗（或托珠单抗单独）联合抗炎治疗会严重增加继发性致死性细菌或真菌感染的风险。因此，用这些抗炎药治疗高危人群（即老年人和老年患者）需要每天进行临床评估，定期监测 C 反应蛋白和降钙素原，并对血液、尿液和痰液进行标准培养，以便尽快发现合并感染。
