title: Penicillin-resistant Streptococcus mitis as a cause of septicemia with meningitis in febrile neutropenic children.
abstract: OBJECTIVE
  The purpose of this report is to emphasize the importance of occurrence of Streptococcus mitis meningitis in febrile neutropenic children with hematopoietic malignancy.
  
  
  METHODS
  Symptoms of meningitis and sepsis (fever, headache, changes in mental status) were seen in three patients who were severely neutropenic and undergoing cytotoxic chemotherapy for CNS relapse of their underlying malignancy (acute lymphoblastic leukemia (ALL), n = 2; Burkitt's lymphoma, n = 1). Chemotherapy had included cytosine arabinoside administered 7-14 days prior to presenting with sepsis and meningitis. All three patients had buccal mucositis or sinusitis. Blood cultures and CSF cultures showed S. mitis resistant to penicillin but sensitive to vancomycin. Vancomycin, at a dosage of 60 mg/kg/day to maximize CNS levels of antibiotic, was administered to all three children.
  
  
  RESULTS
  Two of the patients recovered from S. mitis meningitis; recovery was associated with an improvement in their peripheral granulocyte counts. One patient, who remained neutropenic, died despite being treated with both intravenous and intraventricular vancomycin.
  
  
  CONCLUSIONS
  Physicians caring for patients who are neutropenic and febrile need to be aware of the risk of meningitis occurring with S. mitis sepsis. Early treatment with high dosages of vancomycin (60 mg/kg/day) and an attempt to limit the duration of neutropenia are important factors in the outcome of such patients.
authors.affiliation: Department of Pediatrics, Michigan State University, East Lansing 48824-1316, U.S.A.
authors.forename: D R
authors.initials: DR
authors.lastname: Balkundi
authors.forename: D L
authors.initials: DL
authors.lastname: Murray
authors.forename: M J
authors.initials: MJ
authors.lastname: Patterson
authors.forename: R
authors.initials: R
authors.lastname: Gera
authors.forename: A
authors.initials: A
authors.lastname: Scott-Emuakpor
authors.forename: R
authors.initials: R
authors.lastname: Kulkarni
mesh_terms: D016470:Bacteremia / Q000188:drug therapy / Q000209:etiology*; D002051:Burkitt Lymphoma / Q000097:blood / Q000150:complications*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy / Q000209:etiology*; D009503:Neutropenia / Q000150:complications*; D010403:Penicillin Resistance; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000097:blood / Q000150:complications*; D013290:Streptococcal Infections / Q000188:drug therapy / Q000209:etiology*; D013291:Streptococcus / Q000302:isolation & purification*