MIXED MENINGITIS DUE TO STREPTOCOCCUS PNEUMONIAE AND MYCOBACTERIUM TUBERCULOSIS.

Raj Kishor Sharma; Sudhir Kumar; Namrata Kumari; Shailesh Kumar

Volume : VII, Issue : VIII, August - 2018

MIXED MENINGITIS DUE TO STREPTOCOCCUS PNEUMONIAE AND MYCOBACTERIUM TUBERCULOSIS.

Raj Kishor Sharma, Sudhir Kumar, Namrata Kumari, Shailesh Kumar

Abstract :

Meningitis is a medical emergency which needs prompt diagnosisand early initiation of therapy. Meningitis can be aseptic, pyogenic,fungal, parasitic, tuberculous, chemical or mixed type. Here, we report arare case of mixed meningitis caused by Mycobacterium tuberculosis and

Streptococcus pneumoniae in adult female presenting with fever, headache and vomiting for 15 days .Investigations revealed raised Neutrophils(86%), chest X–ray (CXR:suggestive of milliary tuberculosis).On cereo–spinal fluid (CSF)examination, sugar level was low, protein markedly high, raised Adenosinedeaminase (ADA),cytology showed predominantly polymorphonuclear cells andGram staining showed pus cells with Gram–positive diplococci. India Inkstaining using Anthony‘s method revealed capsulated diplococci, howeverculture was negative. Patient did not respond well to ceftriaxone and vancomycin. Gene–Xpert detected Mycobacterium tuberculosis but no resistance torifampicin. Zeihl–Neelsen (ZN) staining of CSF was negative. Patientimproved very well after addition of anti– tubercular drugs. Sinceclinical features do not suffice, even conventional microbiologicaldiagnostic tests like Gram staining & India Ink staining could be crucialin the diagnosis of pyogenic meningitis and prompt initiation ofantimicrobial therapy especially in resource poor countries. Rarelypyogenic meningitis may be associated with tuberculousmeningitis.Considering high burden of tuberculosis in India, it is wiserto send CSF for ZN staining & Gene Xpert even in proven cases of pyogenicmeningitis. Early diagnosis and initiation of anti– tubercular therapywill reduce morbidity and mortality associated with tuberculousmeningitis and fulfillment of our dream of "TB MUKT BHARAT".