Abstract
Kocuria spp, previously classified as the members of Micrococcacae family, was rarely reported as a human pathogen. <i>Kocuria Kristinae</i> could cause invasive infections of large variety of tissues in patients of any age. We report the first case of meningitis with sixth and third nerve palsies secondary to sphenoid sinusitis caused by <i>Kocuria Kristinae</i> in a previously healthy 13 year-old boy. In effect, his cerebrospinal fluid (CSF) showed a cloudy appearance of the CSF, white blood cells count was 600 cells/µl (polymorphs 90% and 10% lymphocytes), red blood cells count was 200 cells/µl, protein level was elevated at 5.3 g/l and glucose level was low at 0.1 mmol/l. The direct examination showed positive-gram diplococci. The patient was initially treated with intravenous cefotaxim and vancomycin. The CSF culture was positive for gram-positive diplococci, which was identified as <i>Kocuria kristinae</i>. The meningitis was characterized by insidious evolution and persistent very low CSF glucose level. It was difficult to diagnose the sphenoid sinusitis because it is not accessible to direct clinical examination. It was diagnosed after the occurrence of a complication due to its anatomical location and proximity to the intracranial and orbital content. At day 5, the patient had remarkable resolution of symptoms. Complete recovery of cranial nerve palsy was noted at day 8. The aim of this case report is to present the first isolation of <i>Kocuria Kristinae</i> from cerebrospinal fluid sample and describe the clinical presentation and management outcomes.
Highlights
Kocuria species are ubiquitous in the environment, commensal of the skin and mucosa [1]
We report a case of peadiatric bacterial meningitis with sixth and third nerve palsies secondary to sphenoid sinusitis
Blood cultures and a diagnostic lumbar puncture were performed prior to the administration of antibiotics. His cerebrospinal fluid (CSF) showed: a cloudy appearance of the CSF, white blood cells (WBC) count was 600 cells/μl, red blood cells (RBC) count was 200 cells/μl, protein level was elevated at 5.3 g/l and glucose level was low at 0.1 mmol/l
Summary
Kocuria species are ubiquitous in the environment, commensal of the skin and mucosa [1]. Infectious pathologies caused by Kocuria species are uncommon and mostly present in immunocompromised individuals [2]. Meningitis caused by Kocuria is still limited in the literature. There are two documented cases of meningitis caused by Kocuria rosea [3, 4]. We report a case of peadiatric bacterial meningitis with sixth and third nerve palsies secondary to sphenoid sinusitis. To the best of our knowledge, this is the first report of meningitis caused by Kocuria kristinae. The purpose of this case report is to describe the clinical presentation and management outcomes of this condition
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