title: [Meningitis and white matter lesions due to Streptococcus mitis in a previously healthy child].
abstract: Streptococcus mitis, an important member of viridans streptococci, is found in the normal flora of the oropharynx, gastrointestinal tract, female genital tract and skin. Although it is of low  pathogenicity and virulence, it may cause serious infections in immunocompromised patients. Meningitis caused by S.mitis has been described in patients with previous spinal anesthesia, neurosurgical procedure, malignancy, bacterial endocarditis with neurological complications and alcoholics, but it is rare in patients who are previously healthy. In this report, a rare case of meningoencephalitis caused by S.mitis developed in a previously healthy child has been presented. A previously healthy eight-year-old girl who presented with fever, altered state of consciousness, and headache was hospitalized in intensive care unit with the diagnosis of meningitis. Past history revealed that she was treated with amoxicillin-clavulanate for acute sinusitis ten days before her admission. Whole blood count revealed the followings: hemoglobin 13 g/dl, white blood cell count 18.6 x 109/L (90% neutrophils), platelet count 200 x 109/L and 150 leucocytes were detected on cerebrospinal fluid (CSF) examination. Protein and glucose levels of CSF were 80 mg/dl and 40 mg/dl (concomitant blood glucose 100 mg/dl), respectively. Brain magnetic resonance imaging (MRI) revealed widespread white matter lesions, and alpha-hemolytic streptococci were grown in CSF culture. The isolate was identified as S.mitis with conventional methods, and also confirmed by  VITEK2 (bioMerieux, France) and API 20 STREP (bioMerieux, France) systems. Isolate was found susceptible to penicillin, erythromycin, clindamycin, tetracycline, cefotaxime, vancomycin and chloramphenicol. Regarding the etiology, echocardiography revealed no vegetation nor valve pathology, and peripheral blood smear showed no abnormality. Immunoglobulin and complement levels were within normal limits. Ongoing inflammation in maxillary sinuses detected in brain MRI suggested that meningitis could be related to previous sinus infection. After 14 days of ceftriaxone treatment, the patient was discharged from the hospital with cure. The aim of this case presentation was to emphasize that S.mitis may cause meningitis and white matter lesions in previously healthy children with concomitant sinusitis.
authors.affiliation: Gaziantep Children's Hospital, Gaziantep, Turkey. reyhanyis@yahoo.com
authors.forename: Reyhan
authors.initials: R
authors.lastname: Yiş
authors.forename: Ciğdem Nükhet
authors.initials: CN
authors.lastname: Yüksel
authors.forename: Umit
authors.initials: U
authors.lastname: Derundere
authors.forename: Uluç
authors.initials: U
authors.lastname: Yiş
mesh_terms: D001921:Brain / Q000473:pathology; D002555:Cerebrospinal Fluid / Q000737:chemistry / Q000166:cytology / Q000382:microbiology; D002648:Child; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008279:Magnetic Resonance Imaging; D015523:Maxillary Sinusitis / Q000150:complications* / Q000382:microbiology; D016920:Meningitis, Bacterial / Q000175:diagnosis / Q000382:microbiology*; D013290:Streptococcal Infections / Q000175:diagnosis / Q000382:microbiology*; D034361:Streptococcus mitis / Q000302:isolation & purification* / Q000472:pathogenicity