Pneumococcal meningitis associated with glomerulonephritis: A case report
Abstract
Introduction. Streptococcus pneumoniae is the second most common cause of meningitis in children, producing more serious complications than other bacteria. Streptococcus pneumoniae infections are a rare trigger of glomerulonephritis. We presented a case of glomerulonephritis developing concurrently with meningitis in a young male child. Case report. Gross haematuria, significant proteinuria, hypertension and decreased level of C3 alongside the signs of central nervous system involvement occurred in a male patient of 5 years and 3 months of age. Spontaneous resolution of renal affliction parameters followed the successful treatment of meningitis. The disease course was strongly suggestive of postinfectious glomerulonephritis, although it manifested at the same time as meningitis. The absence of the latent period might point to the development of IgA nephropathy, but since the renal function was stable, without any abnormalities in urine tests documented during follow-up, our opinion is that this was rather the case of postinfectious nephropathy. Conclusion. The presented case is a unique clinical form of postinfectious glomerulonephritis. An accurate diagnosis of this entity should ensure the adequate treatment and follow-up of these patients.
References
Bogaert D, De Groot R, Hermans PW. Streptococcus pneumoniae colonisation: The key to pneumococcal disease. Lancet Infect Dis 2004; 4(3): 144−54.
National Collaborating Centre for Women's and Children's Health (UK). Bacterial meningitis and meningococcal septicaemia: Management of bacterial meningitis and meningococcal septi-caemia in children and young people younger than 16 years in primary and secondary care. NICE Clinical Guidelines, No. 102. London, UK: London: RCOG Press; 2010.
Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld MW, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 2004; 39(9): 1267−84.
Stockmann C, Ampofo K, Byington CL, Filloux F, Hersh AL, Blaschke AJ, et al. Pneumococcal meningitis in children: Epi-demiology, serotypes, and outcomes from 1997-2010 in Utah. Pediatrics 2013; 132(3): 421−8.
Kim KS. Acute bacterial meningitis in infants and children. Lancet Infect Dis 2010; 10(1) 32−42.
All Sites-Edmonton Zone. Vancomycin Monitoring and Dos-ing Guideline. [cited 2015 Oct 22]. Available from: http://www.albertahealthservices.ca/assets/Workflows/LabServices/wf-lab-vancomycin-monitoring-and-dosing-guideline.pdf
Pritchard L, Baker C, Leggett J, Sehdev P, Brown A, Bayley BK. In-creasing vancomycin serum trough concentrations and inci-dence of nephrotoxicity. Am J Med 2010; 123(12): 1143−9.
Arditi M, Mason EO, Bradley JS, Tan TQ, Barson WJ, Schutze GE, et al. Three-year multicenter surveillance of pneumococcal meningitis in children: Clinical characteristics, and outcome re-lated to penicillin susceptibility and dexamethasone use. Pedia-trics 1998; 102(5): 1087−97.
Biernath KR, Reefhuis J, Whitney CG, Mann EA, Costa P, Eichwald J, et al. Bacterial meningitis among children with cochlear implants beyond 24 months after implantation. Pediatrics 2006; 117(2): 284−9.
Miller ML, Gao G, Pestina T, Persons D, Tuomanen E. Hypersus-ceptibility to invasive pneumococcal infection in experimental sickle cell disease involves platelet-activating factor receptor. J Infect Dis 2007; 195(4): 581−4.
Beek D, Gans J, Tunkel AR, Wijdicks EF. Community-acquired bacterial meningitis in adults. N Engl J Med 2006; 354(1): 44−53.
Weisfelt M, Gans J, Poll T, Beek D. Pneumococcal meningitis in adults: New approaches to management and prevention. Lan-cet Neurol 2006; 5(4): 332−42.
Brouwer MC, Tunkel AR, Beek D. Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. Clin Mi-crobiol Rev 2010; 23(3): 467−92.
Regev-Yochay G, Raz M, Dagan R, Porat N, Shainberg B, Pinco E, et al. Nasopharyngeal carriage of Streptococcus pneumoniae by adults and children in community and family settings. Clin Infect Dis 2004; 38(5): 632−9.
Margolis E, Yates A, Levin BR. The ecology of nasal colonization of Streptococcus pneumoniae, Haemophilus influenzae and Staphylococcus aureus: The role of competition and inte-ractions with host's immune response. BMC Microbiology 2010; 10: 59.
Carratalà J, Mykietiuk A, Fernández-Sabé N, Suárez C, Dorca J, Verdaguer R, et al. Health care-associated pneumonia requiring hospital admission: Epidemiology, antibiotic therapy, and clin-ical outcomes. Arch Intern Med 2007; 167(13): 1393−9.
Juhn YJ, Kita H, Yawn BP, Boyce TG, Yoo KH, McGree ME, et al. Increased risk of serious pneumococcal disease in patients with asthma. J Allergy Clin Immunol 2008; 122(4): 719−23.
Chao Y, Chiu N, Huang F. Clinical features and prognostic fac-tors in childhood pneumococcal meningitis. J Microbiol Im-munol Infect 2008; 41(1): 48−53.
Okada N, Liszewski MK, Atkinson JP, Caparon M. Membrane cofactor protein (CD46) is a keratinocyte receptor for the M protein of the group A streptococcus. Proc Natl Acad Sci U.S.A. 1995; 92(7): 2489−93.
Elm C, Braathen R, Bergmann S, Frank R, Vaerman J, Kaetzel CS, et al. Ectodomains 3 and 4 of human polymeric Immunoglo-bulin receptor (hpIgR) mediate invasion of Streptococcus pneumoniae into the epithelium. J Biol Chem 2004; 279(8): 6296−304.
Kaetzel CS. Polymeric Ig receptor: Defender of the fort or Tro-jan horse. Curr Biol 2001; 11(1): R35−8.
Ku C, Picard C, Erdös M, Jeurissen A, Bustamante J, Puel A, et al. IRAK4 and NEMO mutations in otherwise healthy children with recurrent invasive pneumococcal disease. J Med Genet 2007; 44(1): 16−23.
Ku CL, Yang K, Bustamante J, Puel A, von Bernuth H, Santos OF, et al. Inherited disorders of human Toll-like receptor signaling: Immunological implications. Immunol Rev 2005; 203: 10−20.
Currie AJ, Davidson DJ, Reid GSD, Bharya S, MacDonald KL, De-von RS, Speert DP. Primary immunodeficiency to pneumococcal infection due to a defect in Toll-like receptor signaling. J Pediatr 2004; 144(4): 512−8.
von Bernuth H, Picard C, Jin Z, Pankla R, Xiao H, Ku C, et al. Pyogenic bacterial infections in humans with MyD88 deficien-cy. Science 2008; 321(5889): 691−6.
Picard C, Casanova J, Puel A. Infectious diseases in patients with IRAK-4, MyD88, NEMO, or IκBα deficiency. Clin Microbiol Rev 2011; 24(3): 490−7.
Jonsson G, Truedsson L, Sturfelt G, Oxelius VA, Braconier JH, Sjöholm AG. Hereditary C2 deficiency in Sweden: Frequent oc-currence of invasive infection, atherosclerosis, and rheumatic disease. Medicine (Baltimore) 2005; 84(1): 23−34.
Tomasz A, Moreillon P, Pozzi G. Insertional inactivation of the major autolysin gene of Streptococcus pneumoniae. J Bacteriol 1988; 170(12): 5931−4.
Tuomanen E, Liu H, Hengstler B, Zak O, Tomasz A. The induc-tion of meningeal inflammation by components of the pneu-mococcal cell wall. J Infect. Dis 1985; 151(5): 859−68.
Nau R, Eiffert H. Minimizing the release of proinflammatory and toxic bacterial products within the host: A promising ap-proach to improve outcome in life-threatening infections. FEMS Immunol. Med Microbiol 2005; 44(1): 1−16.
Horstkotte D, Follath F, Gutschik E, Lengyel M, Oto A, Pavie A, et al. Guidelines on Prevention, Diagnosis and Treatment of In-fective Endocarditis Executive Summary The Task Force on Infective Endocarditis of the European Society of Cardiology. Eur Heart J 2004; 25(3): 267−76.
Gatzoulis MA, Winrow A, Kovar IZ. Acute endocarditis following pneumococcal meningitis. Eur J Pediatr 1993; 152(4): 323−4.
Ashley EA, Niebauer J. Cardiology Explained. London: Reme-dica; 2004.
Lee C, Chen M, Chiou Y, Shen C, Wu C, Chiou Y. Invasive pneumococcal pneumonia is the major cause of paediatric haemolytic-uraemic syndrome in Taiwan. Nephrology (Carl-ton) 2012; 17(1): 48−52.
Levi M, Poll T. Inflammation and coagulation. Crit Care Med 2010; 38(2): 26−34.
Waters AM, Kerecuk L, Luk D, Haq MR, Fitzpatrick MM, Gilbert RD, et al. Hemolytic uremic syndrome associated with invasive pneumococcal disease: The United kingdom experience. J Pe-diatr 2007; 151(2): 140−4.
Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health surveillance. MMWR Recomm Rep 1997; 46(RR−10):1−55.
CHARGE A/S Canadian Paediatric Surveillance Program 2002 Results. Ottawa: Canadian Paediatric Society; 2003.
Corriere JN Jr, Lipshultz LI. Pneumococcal nephritis. Urology 1974; 3(5): 557−61.
Schachter J, Pomeranz A, Berger I, Wolach B. Acute glomerulo-nephritis secondary to lobar pneumonia. Int J Pediatr Nephrol 1987; 8(4): 211−4.
Phillips J, Palmer A, Baliga R. Glomerulonephritis associated with acute pneumococcal pneumonia: A case report. Pediatr Nephrol 2005; 20(10): 1494−5.
Ismail IH, Zainudin Z, Othman N. Pneumococcal glomerulo-nephritis in a healthy child: A case report and literature review. Singapore Med J 2014; 55(5): e69−72.
Tasic V. Postinfectious glomerulonephritis. In: Geary DF, Franz SF, editors. Comprehensive Pediatric Nephrology. 1th ed. Philadelphia: Mosby Elsevier; 2008. p. 309−17.
Kaehny WD, Ozawa T, Schwarz MI, Stanford RE, Kohler PF, McIn-tosh RM. Acute nephritis and pulmonary alveolitis following pneumococcal pneumonia. Arch Intern Med 1978; 138(5): 806−8.
Hibino S, Hoshino A, Fujii T, Abe Y, Watanabe S, Uemura O, et al. Post-streptococcal acute glomerulonephritis associated with pneumococcal infection. Pediatr Int 2013; 55(5): e136−8.
Wolach B, Uziel Y, Berger I, Pomeranz A. Cat-scratch bacillus and Streptococcus pneumoniae causing submandibular suppurative adenitis and acute glomerulonephritis. Child Nephrol Urol 1990; 10(3): 158−60.
Carceller LF, Torre EM, Porto AR, Écija PJ. Acute glomerulo-nephritis associated with pneumonia: A review of three cases. Pediatr Nephrol 2010; 25(1): 161−4.
Hyman LR, Jenis EH, Hill GS, Zimmerman SW, Burkholder PM. Alternative C3 pathway activiation in pneumococcal glomeru-lonephritis. Am J Med 1975; 58(6): 810−4.
Morin D, Ichay I, Dumas ML, Valette H, Dumas R. Membrano-proliferative glomerulonephritis in a 10-year-old boy with pneumococcal pneumonia. Pediatr Nephrol 1990; 13: C58.
Coppo R, Amore A. IgA nephropathy. In: Geary DF, Schaefer F, editors. Comprehensive Pediatric Nephrology. 1th ed. Phila-delphia: Mosby Elsevier; 2008. p. 291−9.
Drew PA, Nieuwhof WN, Clarkson AR, Woodroffe AJ. Increased concentration of serum IgA antibody to pneumococcal poly-saccharides in patients with IgA nephropathy. Clin Exp Im-munol 1987; 67(1): 124−9.
Kukuminato Y, Hamamoto M, Kataura A. Role of serum antibo-dies to streptococci in patients with IgA nephropathy. Acta Otolaryngol Suppl 1993; 508: 6−10.