A clinical case of the central nervous system mixed infection (staphylococcal and tuberculosis) in a two-year-old boy

Abstract

Inflammatory diseases of the substance and membranes of the brain are characterized by high mortality (1025% in developed countries and 5470% in countries with limited resources). One of the features of the infectious pathology of the central nervous system is the polyetiology of pathogens, and in cases of mixed infection, there is always a problem of differential diagnosis and the appointment of adequate etiotropic therapy. Staphylococcal meningoencephalitis occurs in 6.9% of cases of infectious lesions of the central nervous system, while the risk group consists of children with an immunodeficiency condition. The proportion of tuberculous lesions of the central nervous system is extremely small and is only 0.050.07% of all children with tuberculosis. A clinical observation of a severe course of mixed infection of the central nervous system in a two-year-old child is presented. The peculiarity of this clinical case is a rare combination of staphylococcal and tuberculous etiology of nervous system damage. The dynamics of the patients condition during 32 days in the ICU is described. The emphasis is placed in the areas of intensive care and the role of the influence of adequate etiotropic therapy on the outcome of the disease (in this case, broad-spectrum antibiotics in combination with anti-tuberculosis drugs) is noted. Despite the medical care provided, the outcome of the disease in the child is the formation of subdural bilateral empyema of the frontal region, ventriculitis and occlusive triventricular hydrocephalus, which entails a high risk of further disability. The presented clinical case describing the course and outcome of a rare combination of pathogens of meningoencephalitis is an example of the need for extended differential diagnosis outside the standard search both at the outpatient and inpatient stages of patient management.