case of community-onset meningitis caused by hospital methicillin-resistant staphylococcus aureus successfully treated with linezolid and rifampicin

ABSTRACT

To report a relatively rare presentation of methicillin-resistant Staphylococcus aureus [MRSA] meningitis in a previously healthy boy in Kuwait. A 14-year-old boy presented with a 2 weeks' history of headache and fever with increasing severity. He developed photophobia and double vision 2 days prior to his hospital visit and received ceftriaxone for 6 days prior to admission to the hospital. There was no history of head trauma or neurosurgical operation. Lumbar puncture revealed a slightly turbid cerebrospinal fluid with pleocytosis and greatly reduced glucose, elevated protein level and on culture grew MRSA. Staphylococcal chromosome cassette mec [SCCmec] typing revealed that it belonged to SCCmec type III and sequence type 238 [ST238-SCCmec-lll]. Polymerase chain reaction screening for the presence of Panton-Valen-tine leukocidin [PVL] genes yielded a negative result; all these findings were consistent with hospital-acquired MRSA. He was treated with intravenous linezolid and rifampicin for 2 weeks, made good response and was discharged home fully recovered and well. Hospital MRSA should be considered in the differential diagnosis of the causative agents of community-onset meningitis in healthy patients even without predisposing factor