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Correspondence

Indian Pediatr 2016;53: 931

Staphylococcus xylosus Meningitis Following Dog-bite

 

Amitabh Singh and *Rahul Jain

Department of Pediatrics, Chacha Nehru Bal Chikitsalaya, Geeta Colony, New Delhi, India.
Email: [email protected]
 

 


After animal bites, commensals present in the oral cavity of animals can cause serious infections. A 9-year-old boy presented with history of dog-bite 8 days ago, fever for 6 days, and headache and giddiness for 4 days. He had a dog-bite on right forearm and thigh with bleeding from the wound site. He was treated at a local hospital where he received two doses of rabies vaccines three days apart along with wound care. Anti-rabies serum was not given. After 48 hours of bite, he started having fever, headache and giddiness. At presentation, child was conscious but irritable, with presence of meningeal signs and up-going plantars. There was no aerophobia or hydrophobia. A differential diagnosis of rabies and aseptic/pyogenic meningitis was considered and child was empirically started on intravenous ceftriaxone and acyclovir.

His hemogram showed total leukocyte count of 4.91×109 with 62% neutrophils: C-reactive protein was 56.1 mg/L. CSF examination showed 20 cells/µL with 75% lympho-cytes and 25% polymorphs. CSF sugar was 100.1 mg/dL against blood sugar of 145 mg/dL and protein was 23.2 mg/dL. CSF gram stain was unremarkable. The CSF culture (Bactec) showed growth after 48 hours of incubation. On subculture, the growth showed non-hemolytic, catalase positive, coagulase negative, gram positive cocci in clusters. Further processing was done by Vitek 2C systems (Biomerieux, France). Growth was identified as Staphylococcus xylosus, sensitive to oxacillin, gentamicin, ciprofloxacin, levofloxacin, clindamycin, teicoplanin, vancomycin, tetracycline, tigecycline and trimethoprim-sulpha-methoxazole, and resistant to penicillin and erythromycin. The child become asymptomatic on antibiotics within three days and these were continued for a total of 10 days.

After dog-bite, meningitis due to commensals present in dog’s oral cavity like Capnocytophaga Canimorsus, and Pasteurella Multocida have been reported [1,2]. Most of these reports are in patients who had no known immune deficiency disorder. S. xylosus is reported as the most frequently isolated coagulase-negative species from skin and mucous membrane of healthy dogs [3]. It is known to cause serious infections, mostly in immunocompromised hosts; however, it has never been reported as a cause of meningitis [4].

Acknowledgement: Dr Charu Nayyar, Senior Resident, Department of Microbiology, Chacha Nehru Bal Chikitsalaya for help in microbiological inputs.

References

1. Le Moal G, Landron C, Grollier G, Robert R, Burucoa C. Meningitis due to Capnocytophaga canimorsus after receipt of a dog bite: Case report and review of the literature. Clin Infect Dis. 2003;36:e42-6.

2. Weber DJ, Wolfson JS, Swartz MN, Hooper DC. Pasteurella multocida infections. Report of 34 cases and review of the literature. Medicine (Baltimore). 1984; 63:133-54.

3. Cox HU, Hoskins JD, Newman SS, Foil CS, Turnwald GH, Roy AF. Temporal study of staphylococcal species on healthy dogs. Am J Vet Res. 1988;49:747-51.

4. Akhaddar A, Elouennass M, Naama O, Boucetta M. Staphylococcus xylosus isolated from an otogenic brain abscess in an adolescent. Surg Infect (Larchmt). 2010;11:559-61.

 

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