Community acquired methicillin resistant staphylococcus aureus (MRSA) meningitis in an immunocompetent individual .
- Author:
Jo Ann R SOLIVEN
- Publication Type:Others
- Keywords:
34-year-oldCommunity-acquiredMrsaImmunocompetentSevere And Life Threatening Infections
- MeSH:
Human;
Female;
Adult;
Methicillin-resistant Staphylococcus Aureus;
Bacteria;
Endospore-forming Bacteria;
Gram-positive Endospore-forming Bacteria;
Gram-positive Endospore-forming Rods;
Staphylococcaceae;
Community-acquired Infections;
Immune System Phenomena;
Staphylococcus;
Staphylococcus Aureus;
Immunocompetence;
Meningitis;
Nervous System Diseases;
Central Nervous System Diseases;
Central Nervous System Infections
- From:
Philippine Journal of Neurology
2008;12(2):35-35
- CountryPhilippines
-
Abstract:
SYNOPSIS: Methicillin resistant staphylococcus aureus (MRSA) is not a common cause of meningitis in an immnuno-competent individual in the community setting. I report a case of a previously healthy 34 year old female who presented with the classic triad of meningitis secondary to community acquired MRSA infection.CLINICAL PRESENTATION: This is a case of a 34 year old female, Filipino from Caloocan City who presented with high grade fever on admission with a 2-day history of upper back pain, later accompanied by neck stiffness, intermittent headache and low grade fever. Except for a minor skin lesion described as scalp excoriations at parietal area of the head, there was no significant finding on systemic physical examination. Neurological examination initially showed a terminal nuchal rigidity becoming more pronounced and accompanied by positive Brudzinski and Kernig's signs on the second hospital day. Cranial CT scan showed no significant findings, blood and wound cultures showed Staphylococcus aureus resistant to oxacillin and other beta lactam antibiotics. Complete blood count showed elevated white cell count with neutrophilia. Initial chest radiograph showed pneumonia on the right middle lobe with progression of infiltrates and pleural effusion in the succeeding tests. Lumbar tap showed normal pressure but cerebrospinal flnid (CSF) analysis was typical of bacterial meningitis. She improved with the administration of Vancomycin in the earlier stages and Linezolid on the later stages. A skin infection secondary to community acquired MRSA infection with bacteremia and meningitis with concomitant pneumonia contributed to the rarity of this case.SIGNIFICANCE: This report aims to raise the importance of a more extensive study on CA-MRSA infections as well as encourage high index of suspicion for MRSA meningitis not only in the immunocompromised, hospitalized and post surgical patients, but also in immunocompetent patients with minor community acquired MRSA infections.
