[A case of bacterial meningitis due to Streptococcus bovis in an infant with normal cerebrospinal fluid findings at the first CSF examination].

Streptococcus bovis very occasionally causes rarely sepsis, endocarditis, and meningitis in newborns and the elderly. We report the case of infant meningitis caused by S. bovis despite normal cerebrospinal fluid (CSF) findings at the first CSF examination. A 77-day-old boy with 21-trisomy and patent foramen ovale and seen for a high fever underwent blood examination and lumbar puncture due to toxic appearance despite a lack of meningeal signs, and was admitted. His CSF findings were normal and he was given intravenous ceftriaxone against potential bacteremia. He had systemic seizures with continuous fever for 2 days after admission and a second CSF examination. Gram-positive coccus grew from his CSF at the first examination, and CSF cells from the second lumbar puncture increased to 4060/tL (86% neutrophils), so vancomycin was added against potential enterococcal meningitis. S. bovis was finally grown from the first CSF, ceftriaxone discontinued, and intravenous ampicillin added. He recovered after 20 days of antibiotic administration. S. bovis becomes a potential pathogen for meningitis in infants, and must be considered as a cause of meningitis despite its very rarity. CSF findings at the first lumbar puncture may be normal for meningitis in newborns and infants at the first CSF examination, so we must be very careful in the diagnosis of bacterial meningitis even with normal CSF findings, and considered antibiotic treatment against potential bacterial meningitis.

Genotypes of macrolide-resistant pneumococci from children in southwestern Japan: raised incidence of strains that have both erm(B) and mef(A) with serotype 6B clones.

MICs of penicillin G, erythromycin, clarithromycin, clindamycin, azithromycin, and telithromycin were tested for 189 clinical isolates collected during 2002 to 2005 from children in southwestern Japan. Serotyping and polymerase chain reaction for presence of erm(B) and mef(A) were performed. All strains with erm(B) + mef(A) were analyzed by pulsed-field gel electrophoresis (PFGE) and compared to 3 global clones: Spain(23F)-1; Spain(9V)-3 and its variant -14; a South Korean strain same as Taiwan (19F)-14 clone and 5 strains with erm(B) + mef(A) from other countries. Of the 173 macrolide-resistant (erythromycin MIC > or =0.5 microg/mL) strains, 104 (60.1%) had erm(B), 47 (27.2%) had mef(A), and 22 (12.7%) had erm(B) + mef(A). Strains expressing erm(B) or both erm(B) and mef(A) had high macrolide MIC(90)s (>64 microg/mL), except telithromycin (MIC(90), 0.25 microg/mL). Of the 22 erm(B) + mef(A) strains, 10 had 4 distinct PFGE patterns and were mainly serotype 6B clones, which differed from those described in previous reports; 5 other strains had unique profiles.

[Dipylidium caninum infection in an infant].

Dipylidium caninum, the dog tapeworm, is a common intestinal cestode of domestic dogs and cats, but few cases have been reported of human infection by this parasite in Japan. We repot a case of D. caninum infection in a 17 month-old girl, who sometimes had symptoms of abdominal pain, diarrhea, and dysphoria at night. Her mother noted the appearance of small white worms in her stool, and she was seen by a local pediatrician. Despite antiparasitic therapy wiht pyrantel pamoate, the problem persisted and was eventually referred for further workup to Kurume University Hospital. The diagnosis was made by microscopic examination of the excreted proglottids, which contained characteristic egg capsules. She was successfully treated with a singledose of praziquantel and four adult parasites were recovered. The longest intact worm was 32cm. Her family had household pets (a dog and a cat). The pets were seen by the local veterinary and both were evidenced D. caninum. Humans, primarily children, become infected when they accidentally ingest fleas. Parents usually find proglottids as multiple white objects, often described as cucumber, melon, or pumpkin seeds, in stool, diapers, or on the perineum. Most general practitioners and pediatricians may treat children with enterobiasis (pinworm) infection, and in case the treatment fails, other parasite infection should be considered such as this worm. A history of dog or cat pets, fleas, and flea bites may be important clues to diagnosis. Pets found to be infected should also be treated.