Endogenous endophthalmitis complicating Streptococcus equi subspecies zooepidemicus meningitis: a case report.
BACKGROUND
Streptococcus equi subspecies zooepidemicus (Streptococcus zooepidemicus) is a rare cause of meningitis in humans. Humans mainly get infected by contact with an animal source or by ingestion of unpasteurized dairy products. In rare cases, bacterial meningitis can be complicated by endogenous endophthalmitis which is frequently associated with a poor visual prognosis.


METHODS
A 73 year old male Caucasian patient presented with clinical signs indicative of bacterial meningitis. Blood and cerebrospinal fluid cultures yielded beta-hemolytic, catalase-negative cocci. The strain was identified as Streptococcus zooepidemicus. The patient was likely infected by contact with a sick horse. Under antibiotic treatment, his general condition improved rapidly. Early after hospital admission, however, he began seeing a black spot in his left eye's central visual field. An ophthalmological examination revealed signs of endogenous endophthalmitis and so the patient underwent vitrectomy. Despite treatment, the visual acuity of his left eye remained severely impaired. He showed no further neurological deficits at hospital discharge.


CONCLUSIONS
Meningitis caused by Streptococcus zooepidemicus is rare with only 27 previously published adult cases in the literature. Of note, this report constitutes the third description of endogenous endophthalmitis associated with Streptococcus zooepidemicus meningitis. Thus, endogenous endophthalmitis may represent a comparatively common complication of meningitis caused by this microorganism.
Department of Neurology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Universitätsklinikum Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany. Dominik.Madzar@uk-erlangen.de.
Dominik
D
Madžar
Department of Neurology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Universitätsklinikum Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany. Mareike.Hagge@uk-erlangen.de.
Mareike
M
Hagge
Department of Neurology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Universitätsklinikum Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany. Sebastian.Moeller@uk-erlangen.de.
Sebastian
S
Möller
Department of Neurology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Universitätsklinikum Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany. Martin.Regensburger@uk-erlangen.de.
Martin
M
Regensburger
Department of Neurology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Universitätsklinikum Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany. De-Hyung.Lee@uk-erlangen.de.
De-Hyung
DH
Lee
Department of Neurology, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Universitätsklinikum Erlangen, Schwabachanlage 6, 91054, Erlangen, Germany. Stefan.Schwab@uk-erlangen.de.
Stefan
S
Schwab
Mikrobiologisches Institut - Klinische Mikrobiologie, Immunologie und Hygiene, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Universitätsklinikum Erlangen, Wasserturmstraße 3-5, 91054, Erlangen, Germany. Jonathan.Jantsch.extern@uk-erlangen.de.|Present address: Institut für klinische Mikrobiologie und Hygiene, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany. Jonathan.Jantsch.extern@uk-erlangen.de.
Jonathan
J
Jantsch
D000368:Aged; D002555:Cerebrospinal Fluid / Q000382:microbiology; D009877:Endophthalmitis / Q000150:complications* / Q000382:microbiology*; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications* / Q000382:microbiology*; D013290:Streptococcal Infections / Q000150:complications* / Q000382:microbiology*; D018502:Streptococcus equi / Q000302:isolation & purification / Q000502:physiology*