Viridans Group Streptococcus Meningitis in an Immunocompetent Child: A Case Report

Patient: Female, 14-month-old Final Diagnosis: Viridans group streptococcus meningitis Symptoms: Fever • irritability • vomiting Medication: — Clinical Procedure: — Specialty: Infectious Diseases OBJECTIVE: Rare disease BACKGROUND: Viridans group streptococci (VGS) are commensal organisms in humans that are considered contaminants when isolated from culture specimens. However, VGS can be pathogenic when recovered multiple times from blood cultures or when in immunocompromised hosts. VGS are the leading cause of dental abscesses and infective endocarditis in children with underlying congenital heart diseases. They are not commonly involved in meningeal infections, but meningitis due to VGS can be fatal if not treated. The onset is usually preceded by an upper respiratory tract infection or in association with neurological surgical procedures. CASE REPORT: Our patient was a 14-month-old girl with no significant past medical history who presented with fevers and irritability for 2 weeks. A full sepsis workup, including blood, urine, and cerebrospinal fluid (CSF) cultures, was obtained. Culture results were notable for the abundant growth of VGS in the CSF. However, brain imaging and echocardiogram were normal, with no evidence of brain abscesses or cardiac vegetations, respectively. The patient had shown marked clinical improvement after receiving 2 weeks of intravenous ceftriaxone, which was selected based on the VGS susceptibility profile. CONCLUSIONS: Bacterial meningitis is one of the most burdensome infectious diseases worldwide, despite improvements in diagnostic methods, management, and national immunization programs. Clinicians should consider VGS in the differential diagnosis of potential infections that can cause meningitis.