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Neuropediatrics 2011; 42(06): 240-244
DOI: 10.1055/s-0031-1295407
Short Communication
© Georg Thieme Verlag KG Stuttgart · New York

Complicated Pneumococcal Meningitis in a Fully Vaccinated Child: Value of Magnetic Resonance Imaging Monitoring

S. Ilia
1   Pediatric Intensive Care Unit, University Hospital of Heraklion, Heraklion, Crete, Greece
,
A.-M. Spanaki
1   Pediatric Intensive Care Unit, University Hospital of Heraklion, Heraklion, Crete, Greece
,
M. Raissaki
2   Department of Radiology, University Hospital of Heraklion, Heraklion, Crete, Greece
,
V. I. Spoulou
3   1st Department of Pediatrics, Division of Infectious Diseases ‘Aghia Sophia’ Children’s Hospital, Athens University School of Medicine, Athens, Greece
,
M.-D. Fitrolaki
1   Pediatric Intensive Care Unit, University Hospital of Heraklion, Heraklion, Crete, Greece
,
M. Kanariou
4   Department of Immunology – Histocompatibility, “Aghia Sophia” Children’s Hospital, Athens, Greece
,
G. Tzanakaki
5   National Meningitis Reference Laboratory, National School of Public Health, Athens, Greece
,
G. Briassoulis
1   Pediatric Intensive Care Unit, University Hospital of Heraklion, Heraklion, Crete, Greece
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Publikationsverlauf

received 28. Juli 2011

accepted 25. Oktober 2011

Publikationsdatum:
14. November 2011 (online)

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Abstract

We present a unique case of life-threatening pneumococcal meningitis complicated by vasculitis in a fully vaccinated 4-year-old female with the heptavalent conjugate vaccine for Streptococcus pneumoniae (PCV7). Serotype 23F was isolated in both blood and cerebral spinal fluid (CSF) samples. Pulses of methylprednisolone were promptly initiated in addition to antibiotics leading to a good recovery. CSF studies and magnetic resonance imaging (MRI) of the brain were used for diagnosis and monitoring the response to corticoid therapy. We report the investigations of a child with failure of PCV7 vaccine to protect against vaccine-serotype invasive disease. Use of corticosteroids and temporal association with changes in brain imaging are described for the first time in literature.

Key words

meningitis - magnetic resonance imaging - pulse of steroids - vasculitis - Streptococcus pneumonia - PCV7
 

  • References

  • 1 Bartynski WS, Upadhyaya AR, Petropoulou KA et al. Influenza A encephalopathy, cerebral vasculopathy, and posterior reversible encephalopathy syndrome: combined occurrence in a 3-year-old child. Am J Neuroradiol 2010; 31: 1443-1446
    CrossrefPubMedSuche in Google Scholar
  • 2 Brouwer MC, McIntyre P, de Gans J et al. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev 2010; 8 (09) CD004405
    PubMedSuche in Google Scholar
  • 3 Center KJ. Prevenar vaccination: review of the global data, 2006. Vaccine 2007; 25: 3085-3089
    CrossrefPubMedSuche in Google Scholar
  • 4 Iijima S, Shirai M, Ohzeki T. Severe, widespread vasculopathy in late-onset group B streptococcal meningitis. Pediatr Int 2007; 49: 1000-1003
    CrossrefPubMedSuche in Google Scholar
  • 5 Ilias A, Galanakis E, Raissaki M et al. Childhood encephalitis in Crete, Greece. J Child Neurol 2006; 21: 910-912
    CrossrefPubMedSuche in Google Scholar
  • 6 Jorens PG, Parizel PM, Demey HE et al. Meningoencephalitis caused by Streptococcus pneumoniae: a diagnostic and therapeutic challenge. Diagnosis with diffusion-weighted MRI leading to treatment with corticosteroids. Neuroradiology 2005; 47: 758-764
    CrossrefPubMedSuche in Google Scholar
  • 7 Jorens PG, Parizel PM, Wojciechowski M et al. Streptococcus pneumoniae meningoencephalitis with unusual and widespread white matter lesions. Eur J Paediatr Neurol 2008; 12: 127-132
    CrossrefPubMedSuche in Google Scholar
  • 8 Lucero MG, Dulalia VE, Nillos LT et al. Pneumococcal conjugate vaccines for preventing vaccine-type invasive pneumococcal disease and X-ray defined pneumonia in children less than two years of age. Cochrane Database of Systematic Reviews 2009; (04) CD004977
    PubMedSuche in Google Scholar
  • 9 Marchioni E, Tavazzi E, Minoli L et al. Acute disseminated encephalomyelitis. Neurol Sci 2008; 29 (Suppl. 02) S286-S288
    CrossrefPubMedSuche in Google Scholar
  • 10 Rajasingham CR, Bonsu BK, Chapman JI et al. Serious neurologic sequelae in cases of meningitis arising from infection by conjugate vaccine-related and nonvaccine-related serogroups of Streptococcus pneumoniae. Pediatr Infect Dis J 2008; 27: 771-775
    PubMedSuche in Google Scholar
  • 11 Sáez-Llorens X, McCracken Jr GH. Bacterial meningitis in children. Lancet 2003; 361: 2139-2148
    CrossrefPubMedSuche in Google Scholar
  • 12 Spiegel R, Miron D, Lumelsky D et al. Severe meningoencephalitis due to late reactivation of Varicella-Zoster virus in an immunocompetent child. J Child Neurol 2010; 25: 87-90
    CrossrefPubMedSuche in Google Scholar
  • 13 Takada K, Kojima S, Hayashi T et al. Adult bacterial meningitis complicated by cerebral infarction: report of three cases [Article in Japanese]. No To Shinkei 2006; 58: 329-334
    PubMedSuche in Google Scholar