2017 Volume 66 Issue 3 Pages 297-301
We report the case of a 60-year-old female with bacterial meningitis caused by Streptococcus gallolyticus subsp. pasteurianus. The patient originally had ulcerative colitis and occasionally bloody stool as well. She was admitted to the hospital with the chief complaints of fever and headache. She was diagnosed as having bacterial meningitis and initially treated with ceftriaxone (CTRX) and vancomycin (VCM). Although Enterococcus species was suspected as the causative bacterium on the basis of culture results using the patient’s cerebrospinal fluid, S. gallolyticus subsp. pasteurianus was identified instead using VITEK2 after three days of hospitalization. After we determined the drug susceptibility of the bacterium, the antibiotics were changed to benzylpenicillin (PCG), followed by ampicillin (ABPC), and finally changed back to CTRX. Then, her condition improved rapidly and she was discharged after 18 days of hospitalization. This particular type of bacterium is indigenous in the intestinal tract. Because she was originally suffering from ulcerative colitis, it is speculated that the bacterial cells entered the cerebrospinal fluid from the gastrointestinal tract. The appearance of the colonies of this bacterial species is very similar to that of Enterococcus spp. In addition, these two types of bacteria belong to the Lancefield classification Group D. It is, therefore, very difficult to distinguish them from each other. For the correct identification of this bacterial species, it is necessary to use automatic identification devices and/or genetic analysis.
