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Indian Pediatr 2016;53: 931 |
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Staphylococcus xylosus Meningitis
Following Dog-bite
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Amitabh Singh and *Rahul Jain
Department of Pediatrics, Chacha Nehru Bal Chikitsalaya,
Geeta Colony, New Delhi, India.
Email:
[email protected]
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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 4.91×10 9
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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