Acute pyogenic meningoencephalitis due to Streptococcus pneumoniae serotype 11A in a previously healthy child: a case report
DOI:
https://doi.org/10.18203/2320-6012.ijrms20252517Keywords:
Streptococcus pneumoniae, Meningoencephalitis, Non-vaccine serotypeAbstract
Streptococcus pneumoniae is a leading cause of bacterial meningitis in children despite the widespread use of pneumococcal conjugate vaccines (PCVs). We report a case of acute pyogenic meningoencephalitis in a 6-year-old previously healthy male child who presented with high-grade fever, vomiting, and neck stiffness. Cerebrospinal fluid (CSF) analysis revealed neutrophilic pleocytosis, elevated proteins, low glucose, and Gram-positive diplococci. CSF culture confirmed Streptococcus pneumoniae, later identified as serotype 11A - a non-vaccine serotype not covered by PCV10, PCV13, or PCV14. The child responded to intravenous ceftriaxone, vancomycin, dexamethasone, and supportive therapy. This case highlights the clinical features and management of pneumococcal meningoencephalitis due to serotype 11A, underlining the growing burden of non-vaccine serotypes and the importance of extended-serotype vaccines.
Metrics
References
Oliveira GS, Oliveira MLS, Miyaji EN, Rodrigues TC. Pneumococcal vaccines: past findings, present work, and future strategies. Vaccines. 2021;9(11):1338. DOI: https://doi.org/10.3390/vaccines9111338
Ganaie F, Saad JS, McGee L, van Tonder AJ, Bentley SD, Nahm MH, et al. A new pneumococcal capsule type, 11A like (11E), and its emergence post-PCV. Clin Infect Dis. 2021;73(3):e686–e693.
Imöhl M, Reinert RR, van der Linden M. Epidemiology of serotype 11A in Germany: rising incidence post-PCV13. Vaccine. 2020;38(6):1392–7.
Brouwer MC, Tunkel AR, van de Beek D. Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. Clin Microbiol Rev. 2010;23(3):467–92. DOI: https://doi.org/10.1128/CMR.00070-09
Oligbu G, Collins S, Sheppard CL, Fry NK, Andrews NJ, Ladhani SN, et al. Rise of non-vaccine serotypes causing invasive pneumococcal disease in UK children. Lancet Infect Dis. 2021;21(5):751–2.
Pfizer Inc. Prevnar 20. New York: Pfizer; 2021. Available at: https://www.pfizer.com/news/press-release/press-release-detail/european-commission-approves-pfizers-prevenar-20r-help. Accessed on 2 June 2025.
Kim KS. Acute bacterial meningitis in infants and children. Lancet Infect Dis. 2010;10(1):32–42. DOI: https://doi.org/10.1016/S1473-3099(09)70306-8
Beek D, de Gans J, Tunkel AR, Wijdicks EF. Community-acquired bacterial meningitis in adults. N Engl J Med. 2006;354(1):44–53. DOI: https://doi.org/10.1056/NEJMra052116
Thigpen MC, Whitney CG, Messonnier NE, Zell ER, Lynfield R, Hadler JL, et al. Bacterial meningitis in the United States, 1998–2007. N Engl J Med. 2011;364:2016–25. DOI: https://doi.org/10.1056/NEJMoa1005384
Weinberger DM, Malley R, Lipsitch M. Serotype replacement in disease after pneumococcal vaccination. Lancet. 2011;378(9807):1962–73. DOI: https://doi.org/10.1016/S0140-6736(10)62225-8
Danino D, Ben Shimol S, Givon Lavi N, Greenberg D, Dagan R, Avni YS, et al. Understanding vaccine type replacement and dynamics of pneumococcal serotypes. Clin Infect Dis. 2022;75(5):784–91.
Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, et al. Practice guidelines for bacterial meningitis. Clin Infect Dis. 2004;39(9):1267–84. DOI: https://doi.org/10.1086/425368
Brouwer MC, McIntyre P, de Gans J, Prasad K, van de Beek D. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev. 2015;(9):4405. DOI: https://doi.org/10.1002/14651858.CD004405.pub5
Klein JO. Management of acute bacterial meningitis in infants and children. Pediatr Infect Dis J. 1992;11(4):263–7.
John J, Varghese R, Lionell J, Neeravi A, Veeraraghavan B. Non vaccine pneumococcal serotypes among children with invasive pneumococcal disease. Indian Pediatr. 2018;55(10):874–6. DOI: https://doi.org/10.1007/s13312-018-1398-x
Downloads
Published
How to Cite
Issue
Section
