Community-acquired meningitis due to methicillin susceptible Staphylococcus aureus

• Published in: Médecine et maladies infectieuses Vol. 40; no. 3; pp. 156 - 160
• Main Authors: Pinet, P, Denes, E, Garnier, F, Durox, H, Ducroix-Roubertou, S, Weinbreck, P
• Format: Journal Article
• Language: French
• Published: France 01.03.2010
• Subjects: Abscesses; Age; Anti-Bacterial Agents - therapeutic use; Antibiotics; Arthritis; Bacteremia; Cerebrospinal fluid; Community-Acquired Infections - diagnosis; Community-Acquired Infections - drug therapy; Drug resistance; Evolution; Female; Humans; Infection; Leukocytes; Lung; Male; Meningitis; Meningitis, Bacterial - diagnosis; Meningitis, Bacterial - therapy; Methicillin; Methicillin - therapeutic use; Middle Aged; Neurosurgery; Risk factors; Spondylodiscitis; Staphylococcal enterotoxin F; Staphylococcal Infections - diagnosis; Staphylococcal Infections - therapy; Staphylococcus aureus; Staphylococcus aureus - drug effects
• DOI: 10.1016/j.medmal.2009.08.015
• ISSN: 0399-077X

Meningitis due to Staphylococcus aureus is infrequent. MRSA is mainly found after neurosurgery, but MSSA may be involved in community-acquired meningitis. However, this kind of infection is not widely reported, despite its severity. We describe the characteristics of five patients hospitalized in our ward over a period of 18 months who presented with community-acquired meningitis due to MSSA. The patients were three men and two women with a mean age of 62 years. One patient was immunosuppressed. Neurological signs were present at the onset for only two patients. In all cases, there were extraneurological localizations of the infection, mainly in bones (spondylodiscitis, epidural abscess, arthritis) but also lung infection. Three patients with meningeal inflammation also presented with confusion. CSF analysis revealed less than 950 white blood cells, hyper-CSF-proteins, and hypo-CSF-glucose. Bacteraemia was present in all patients. The source of infection was never determined. The evolution was good for all patients with a prolonged antibiotic course. The analysis of genetic determinants for three strains revealed the presence of TSST-1 which could account for the severity of the disease. Community-acquired MSSA meningitis is a serious infection, occurring in patients without risk factors. Hematogenous dissemination leads to multiple tissue infection. A long course of antibiotics, with high doses, is needed to treat meningitis but also extraneurological localizations. The role of TSST-1 needs to be confirmed in other patients.