[Purulent meningitis in an adult patient caused by multi-drug resistant Streptococcus pneumoniae 19A].

UNLABELLED: This is the first report in Hungary about meningitis caused by multiply-resistant Streptococcus pneumoniae in a 54 year old woman. The Streptococcus pneumoniae serotype 19A was highly resistant to penicillin, ampicillin, chloramphenicol, cefuroxime and intermediate resistant to ceftriaxone. The antibiotic treatment was started with penicillin and ampicillin. The antibiotic treatment was changed to vancomycin + ceftriaxone, vancomycin + rifampicin and vancomycin + imipenem on the 2nd, 4th and 11th hospital days, respectively. She died on the 29th day with symptoms of sepsis. Necropsy and microscopic examination of the brain revealed localised inspissed layer of purulent exsudat over the convexities. Under this area the small wessels and capillaries were thrombotic and were surrounded by severe degeneration and necrosis in the white matter.

RECOMMENDATIONS: Streptococcus pneumoniae has to be considered penicillin resistant until the organism is proved to be susceptible to penicillin. The authors advise the administration of dexamethasone, based on their own favourable 7 years experience.