Korean J healthc assoc Infect Control Prev.  2022 Jun;27(1):80-84. 10.14192/kjicp.2022.27.1.80.

Acute Disseminated Pneumococcal Infection with Meningitis and Septic Arthritis Caused by Extensively Drug-resistant Streptococcus pneumoniae

• Shi HJ
• Baek JY
• Chung DR
• Kim K
• Peck KR
• Kang CI

• KMID: 2530831
• DOI: http://doi.org/10.14192/kjicp.2022.27.1.80

Abstract

The emergence and spread of antimicrobial resistance threatens the successful treatment of invasive pneumococcal disease (IPD). We report a case of disseminated pneumococcal infection with meningitis, spondylitis, and septic arthritis caused by an extremely drug-resistant strain of Streptococcus pneumoniae, which was resistant to at least one agent in all classes but was sensitive to vancomycin and linezolid. The patient was treated successfully using intravenous vancomycin (1 g every 12 h) and shoulder surgery. The serotype of this isolate was 15A, a nonvaccine type, and multi-locus sequence typing (MLST) revealed ST8279. MLST analysis and antimicrobial susceptibility test revealed that the strain, SMC1710-32, belonged to ST8279, with the same molecular characteristics with drug susceptibility as extensively drug-resistant (XDR) clone 11A-ST8279 in the previous studies. These XDR pneumococcal strains, serotype 11A and 15A possessed identical molecular characteristics including multiple mutated genes involved in very-high-level resistance to various drugs. The difference in serotype was due to large scale recombination for serotype switching. Further surveillance and investigation of the serotype distribution and genotypes of XDR strains are essential to prevent their spread.

Keyword

Streptococcus pneumoniae; Bacterial meningitis; Extensively drug-resistance (XDR); Disseminated infection; Serotype 15A

Figure

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  Fig. 1 (A) L-spine MRI showed high signal intensity at the L5-S1 intervertebral disc space, with rim enhancing fluid collection at the anterior epidural space and prevertebral area (arrows), and L5-S1 opposite endplate enhancement, suspicious of infectious spondylodiscitis and combined epidural abscess, resulting in canal compromise and right S1 nerve root compression. (B) Shoulder MRI with enhancement showed rim enhancing fluid collection (arrow) in the glenohumeral joint space, subcoracoid, and subacromial-deltoid bursa, suspicious of an inflammatory condition such as infection.

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