Microbiology diagnostic approach in identifying Streptococcus pneumoniae: Case report of Streptococcal meningitis

Introduction: Bacterial meningitis remains a serious global health problem. Streptococcus pneumoniae as the causative organism, is fastidious. Microbiology diagnostic approach is needed to identify S.pneumoniae and antimicrobial susceptibility tests (AST). This study aims to report S. pneumoniae meningitis has been successfully cured strongly related to diagnostic stewardship. Case: A 1 year old child who fell, suffering from vomiting, fever and seizures was brought to the Emergency Department. Multi-slice Computerized Tomography shows cerebral edema and intracerebral hemorrhage. Laboratory blood tests and cerebrospinal fluid analysis strongly indicate bacterial meningitis. Presumptive Gram microscopy of Cerebrospinal Fluid (CSF) and initial identification of CSF cultures on lysed blood agar under microaerophilic conditions, consistently showed lancet-shaped and encapsulated Gram-positive diplococci. Our Clinical Microbiology Laboratory finally identified the growth of S.pneumoniae from blood and CSF cultures. Patients were treated with cefepime 50 mg/kg body weight/8 hours in the first 10 days as empirical and switched later definitively to ciprofloxacin 10 mg/kg body weight/12 hours according to the AST result on day 11 to day 26. On the 31st day, the patient recovered and was discharged. Conclusion: The case of a 1 year-old child with S. pneumoniae meningitis has been successfully cured strongly related to diagnostic stewardship by the Clinical Microbiology Laboratory. Supplementation media with sodium bicarbonate can improve S. pneumoniae recovery as a basis for identification and AST. Proper inoculation and AST need to be accelerated because S.pneumoniae easily undergoes autolysis.