Vol. 114 • September 201726 THE ANTISEPTIC

Case RepoRt

Introduction:

Recurrent bacterial meningitis is defined as two or more episodes of meningitis caused by a different bacterial organism or, alternatively, a second or further episode caused by the same organism with a greater-than-3-week interval after the completion of therapy for the initial episode. Predisposing factors for recurrent bacterial meningitis can be broadly categorized into congenital and acquired conditions and further divided into anatomical abnormalities, immunodeficiencies, and chronic parameningeal infect ions. Bacterial meningitis is believed to result predominantly from blood-borne bacteria invading the cerebrospinal fluid space via the choroid plexus. Mondini dysplasia and other forms of congenital inner ear malformations accounted for a large proportion of cases of recurrent bacterial meningitis.1 Lumbosacral neural tube defects such as meningoceles

Recurrent Bacterial Meningitis: A case reportVineetranjan Gupta, Sunil MhaSke, GaneSh MiSal, ninza rawal

Dr. Vineetranjan Gupta, Resident,Dr. Sunil Mhaske, Prof and Head,Dr. Ganesh Misal, Resident,Dr. Ninza Rawal, Resident,Dept of Paediatrics, DVVPF’s Medical College, Ahmednagar.

Specially Contributed to "The Antiseptic" Vol. 114 No. 9 & P : 26 - 27

abstRaCt

Recurrent Bacterial meningitis is a severe, potentially life-threatening infection that is associated with high rates of morbidity and significant disability in survivors. In recent years, despite improvements in antimicrobial therapy and intensive care support,overall mortality rates related to bacterial meningitis of around 20% to 25% have been reported by major centers . Potential long-term neurological sequelae include cranial nerve palsies, hemiparesis, hydrocephalus, and seizures as well as visual and hearing impairment which can have a profound impact on the quality of life of the survivors. We report a case of Recurrent bacterial meningitis presented to emergency department with complaints of fever, vomiting, headache. In addition to classical clinical presentation of meningitis, HRCT temporal bone supports the cause of recurrent bacterial meningitis.

and meningomyeloceles are classical examples of congenital malformations with abnormal communication between the skin surface and the CSF spaces which causes recurrent bacterial meningitis. Complement deficiencies are generally associated with an increased risk of bacterial infections.2

Here we report a case of a child presented with common symptoms of fever, projectile vomiting, headache present in meningitis.Case report:

A 5years male child presented with history of fever, vomiting, headache and one episode of convulsion on day one of admission. The child has had two diagnosed episodes of Bacterial meningitis in the past 6 months. Deviation of the left eye towards the midline. Deviation of the angle of mouth on the left side, disappearance of the right nasolabial fold were present. Signs of Meningeal irritation were present (Neck stiffness was present, Kernig’s sign was positive, Brudzinski’s neck sign was positive, Brudzinski’s leg sign was positive). Complete blood count was done (Haemoglobin

- 11.3gm%, Tlc - 27400/cumm, platelet – 2.75 lakh/cumm, Neutrophil - 91, Lymphocyte - 06). Cerebrospinal fluid study was indicative of bacterial meningitis (RBC – 15/cumm, TLC - 550/cumm, polymorphs - 60%, lymphocytes – 40%, few monocytes,Gram staining revealed no microorganisms.) Neuroimaging studies revealed no abnormality. HRCT of temporal bone revealed soft tissue density material seen in lateral aspect of right middle ear cavity with thickening of right tympanic membrane with few small calcific densities with in suggestive of

Fig:1

Clinical photo shows deviation of the angle of mouth on the

left side, disappearance of the right nasolabial fold.