title: [A case of bacterial meningitis due to Streptococcus bovis in an infant with normal cerebrospinal fluid findings at the first CSF examination].
abstract: Streptococcus bovis very occasionally causes rarely sepsis, endocarditis, and meningitis in newborns and the elderly. We report the case of infant meningitis caused by S. bovis despite normal cerebrospinal fluid (CSF) findings at the first CSF examination. A 77-day-old boy with 21-trisomy and patent foramen ovale and seen for a high fever underwent blood examination and lumbar puncture due to toxic appearance despite a lack of meningeal signs, and was admitted. His CSF findings were normal and he was given intravenous ceftriaxone against potential bacteremia. He had systemic seizures with continuous fever for 2 days after admission and a second CSF examination. Gram-positive coccus grew from his CSF at the first examination, and CSF cells from the second lumbar puncture increased to 4060/tL (86% neutrophils), so vancomycin was added against potential enterococcal meningitis. S. bovis was finally grown from the first CSF, ceftriaxone discontinued, and intravenous ampicillin added. He recovered after 20 days of antibiotic administration. S. bovis becomes a potential pathogen for meningitis in infants, and must be considered as a cause of meningitis despite its very rarity. CSF findings at the first lumbar puncture may be normal for meningitis in newborns and infants at the first CSF examination, so we must be very careful in the diagnosis of bacterial meningitis even with normal CSF findings, and considered antibiotic treatment against potential bacterial meningitis.
authors.affiliation: Department of Pediatrics and Child Health, Kurume University School of Medicine.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Nagai
authors.forename: Kenji
authors.initials: K
authors.lastname: Gotoh
authors.forename: Shintaro
authors.initials: S
authors.lastname: Hirotaki
authors.forename: Hidenobu
authors.initials: H
authors.lastname: Hidaka
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Koga
authors.forename: Masaaki
authors.initials: M
authors.lastname: Ikenaga
authors.forename: Kenji
authors.initials: K
authors.lastname: Masunaga
authors.forename: Naoki
authors.initials: N
authors.lastname: Tsumura
authors.forename: Koji
authors.initials: K
authors.lastname: Hashimoto
mesh_terms: D006801:Humans; D007223:Infant; D008297:Male; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid* / Q000175:diagnosis; D013290:Streptococcal Infections / Q000134:cerebrospinal fluid* / Q000175:diagnosis; D016985:Streptococcus bovis