A case of community-onset meningitis caused by hospital methicillin-resistant Staphylococcus aureus successfully treated with linezolid and rifampicin.
OBJECTIVE
To report a relatively rare presentation of methicillin-resistant Staphylococcus aureus (MRSA) meningitis in a previously healthy boy in Kuwait.


METHODS
A 14-year-old boy presented with a 2 weeks' history of headache and fever with increasing severity. He developed photophobia and double vision 2 days prior to his hospital visit and received ceftriaxone for 6 days prior to admission to the hospital. There was no history of head trauma or neurosurgical operation. Lumbar puncture revealed a slightly turbid cerebrospinal fluid with pleocytosis and greatly reduced glucose, elevated protein level and on culture grew MRSA. Staphylococcal chromosome cassette mec (SCCmec) typing revealed that it belonged to SCCmec type III and sequence type 238 (ST238-SCCmec-III). Polymerase chain reaction screening for the presence of Panton-Valentine leukocidin (PVL) genes yielded a negative result; all these findings were consistent with hospital-acquired MRSA. He was treated with intravenous linezolid and rifampicin for 2 weeks, made good response and was discharged home fully recovered and well.


CONCLUSIONS
Hospital MRSA should be considered in the differential diagnosis of the causative agents of community-onset meningitis in healthy patients even without predisposing factor.
Al Kandari
M
M
Division of Microbiology, Mubarak Al-Kabir Hospital, and Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait.
Jamal
W
W
Udo
E E
EE
El Sayed
A
A
Al Shammri
S
S
Rotimi
V O
VO
D000081:Acetamides / Q000627:therapeutic use*; D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D000069349:Linezolid; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D055624:Methicillin-Resistant Staphylococcus aureus; D023303:Oxazolidinones / Q000627:therapeutic use*; D012293:Rifampin / Q000627:therapeutic use*
D000081:Acetamides; D000900:Anti-Bacterial Agents; D023303:Oxazolidinones; D000069349:Linezolid; D012293:Rifampin