A case of pneumococcal meningitis with complication diagnosed with polymerase chain reaction

Abstract

Culture results that allow diagnosis and treatment of bacterial meningitis are at the earliest 24-48 hours. Therefore, cell count in cerebrospinal fluid (CSF), biochemical properties of CSF and examination of CSF by Gram staining are of great importance for early diagnosis together with clinical findings. Since the meningitis is an emergency in terms of infection, especially in cases where the empirical treatment is started early without CSF and blood sample collection, or if patients have already received antibiotic treatment, the probability of detection of the agent in culture is reduced or disappeared. In such cases, diagnosis can be made by gram staining of CSF, investigation of bacterial antigens in CSF, and investigation of bacterial DNA by polymerase chain reaction. In this study, a 46-year-old female patient was presented and the literature was reviewed. In the case, ceftriaxone treatment was started without a CSF sample due to a preliminary diagnosis of meningitis. Therefore, no agent was detected in culture, but Streptococcus pneumoniae was found to be positive in CSF by multiplex PCR. Althoug apropriate antimicrobial treatment, the superior sagittal sinus and diffuse cerebral thrombus in bilateral transverses developed as a complication of pneumococcal meningitis.