Clinical and Laboratory Features of Streptococcus salivarius Meningitis: A Case Report and Literature Review

  1. David M. Aronoff, MD#
  1. *Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48109
  2. Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor, MI 48109
  3. Clinical Microbiology Laboratories, Department of Pathology, University of Michigan Medical School, Ann Arbor, MI 48109
  4. §Department of Otolaryngology, University of Michigan Medical School, Ann Arbor, MI 48109
  5. Graduate Program in Immunology and Program in Biomedical Sciences, University of Michigan Medical School, Ann Arbor, MI 48109
  6. #Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI 48109
  1. Corresponding Author: David M. Aronoff, MD, 4618-C Medical Sciences Building II, 1150 West Medical Center Drive, Ann Arbor, MI 48109-5623, Tel: 734-615-3604, Fax: 734-763-4168, Email: daronoff{at}umich.edu

Abstract

Streptococcus salivarius is a normal member of the human oral microbiome that is an uncommon cause of invasive infections. Meningitis is a rare but increasingly reported infection caused by S. salivarius. Despite the growing number of reported cases, a comprehensive review of the literature on S. salivarius meningitis is lacking. We sought to gain a better understanding of the clinical presentation, evaluation, management, and outcome of S. salivarius meningitis by analyzing previously reported cases. In addition to a single case reported here, 64 previously published cases of meningitis were identified for this review. The collected data confirm that most patients presented with classical signs and symptoms of bacterial meningitis with a predominance of neutrophils in the cerebrospinal fluid (CSF) and hypoglycorrhachia. The majority of cases followed iatrogenic or traumatic CSF contamination. Most cases were diagnosed by CSF culture within one day of symptom onset. There was no clear evidence of predisposing co-morbid conditions in patients with meningitis, although in most case reports, limited information was given on the medical history of each patient. Outcomes were generally favorable with antibiotic management. Clinicians should suspect S. salivarius meningitis in patients presenting acutely after medical or surgical procedures involving the meninges.

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