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• Vol.44 No.3
• CLINICA NEUROL, 44: 154−159, 2004
• Vol.44 No.3 contents

Case Report

An adult case of bacterial meningitis caused by penicillin-resistant streptococcus pneumoniae

Yukifusa Igeta M.D.¹⁾²⁾, Koji Ishiguro M.D.¹⁾³⁾ and Koichi Okamoto M.D.⁴⁾

¹⁾Maebashi Red Cross Hospital
²⁾Fujioka general Hospital
³⁾Numata Neurosurgery and Heart Disease Hospital
⁴⁾Department of Neurology, Gunma University School of Medicine

We report a patient of bacterial meningitis caused by penicillin-resistant streptococcus pneumoniae (PRSP). A 50-year-old Japanese man was admitted after developing a fever and quickly falling into unconsciousness. Neurological examination showed slightly consciousness disturbance and meningeal irritation. A lumbar puncture yielded turbid spinal fluid, with increased cell count (411/mm³), protein (685 mg/dl) and IgG (60.3 mg/dl) but decreased glucose (1 mg/dl). Bacterial meningitis was diagnosed and aminobenzylpenicillin (ABPC) and cefotaxime (CTX) were administered immediately, but they were ineffective. Penicillin-resistant streptcoccus pneumoniae (PRSP) was detected in the blood and spinal fluid, so antibiotics were changed to panipenem/betamipron (PAPM/BP) and vancomycin (VCM) with marked efficacy. With the increase in PRSP patients and documented failure in treatment of pneumococcal meningitis with ABPC and CTX, the need for alternative antibiotic therapy is critical. We emphasize the importance of initial therapy with PAPM/BP and VCM in patients with bacterial meningitis from streptcoccus pneumoniae.

(CLINICA NEUROL, 44: 154−159, 2004)
key words: penicillin-resistant streptococcus pneumoniae (PRSP), meningitis, panipenem/betamipron (PAPM/BP), vancomycin (VCM), initial antibiotics

(Received: 14-Mar-03)