Meningitis due to Streptococcus equi in a 73 year old woman with an osteodural defect.

Meningitis caused by Streptococcus equi (SE) is a rare disease associated with high rates of complications. Commonly identified risk factors are regular horse contact and consumption of unpasteurized dairy products. When diagnosed promptly, this infection can be cured. We report the case of a 73 year old woman who presented to the hospital with a sudden holocranial headaches, fever, photophobia, sonophobia, vomiting and behavioural disorders. She lived in a rural area and regularly consumed unpasteurized milk products. She had a medical history of osteodural defect, chronic otitis, high blood pressure and pulmonary fibrosis. We suspected bacterial meningitis associated with an ear infection. A lumbar puncture was performed. Streptococcus equi zooepidemicus(SEZ) was discovered in the CSF's culture. Initially, the patient was treated with ceftriaxone. She had a tonic-clonic seizure 2days later. On the cerebral enhanced MRI, we found a right temporal pored cavity adjacent to a tegmen tympani bone breach. The patient received 15 days of antibiotic therapy with a good outcome. However, she was readmitted 24 h after being discharged for the same initial symptomatology. She received a total of 25 days of antibiotics and 4 days of corticoids with good results. Only a few cases of Streptococcus equi meningitis have been documented. We reported this case to insist on the importance of considering this diagnosis in patients with risk factors. We also point out that severe complications may occur despite the early initiation of adequate treatment.

[Current concepts in the management of pyogenic brain abscesses]. / L'abcès cérébral a pyogènes en milieu médical un problème toujours d'actualité.

Brain abscesses are severe infections with lethal outcome in the case of delay in diagnosis and treatment. The authors report their experience about 30 patients with pyogenic brain abscesses treated between 1989 and 2000. The goal of the study is to analyse epidemiological, clinical and therapeutic aspects of this disease. The sex ratio (M:W) was 2,3 and the mean age was 34 years. Predisposing factors were sepsis of adjacent organs (53%) and bacteremia (30%). The clinical manifestations were: fever (83%), headaches (90%) and focal neurologic signs (57%). CT-scan findings were single lesions in 80% of cases. CT-scan showed a deep ring-enhancing lesion with surrounding edema in 77% of cases. Bacteriological agents in 13 cases (43%) were: 4 Staphylococcus aureus, 2 Neisseria meningitidis and 7 negative Gram bacilli. Medical treatment alone was in 77% of cases; seven patients benefited from medical and neurosurgical approaches. Death occured in 10% of cases.