Primary meningitis caused by Pseudomonas aeruginosa. Recurrence and healing: data on the frequency of meningitis in São Paulo

Abstract

Meningitis caused by Pseudomonas aeruginosa is relatively infrequent and occurs as a rule secondarily, that is as consequence of trauma, otitis, mastoiditis or general infections. The authors present one case of primary meningitis caused by the appointed germ. The patient presented headache, fever and pain on the nape of the neck. The cerebrospinal fluid showed pus and Gram-negative bacilli. Since the beginning the cultures showed a greenish-blue pigment. The cerebrospinal fluid which was kept in the incubator took on the same colour. After 12 days treatment by means of intraspinal injection of penicillin and streptomycin the patient was apparently cured and was sent home. However, one month later the same symptoms reappeared. Spinal puncture brought out pus in which there was the same type of germ. Again intraspinal injections of penicillin and streptomycin were given along with sulphadiazine tablets by mouth. Ten days later the patient was again well and so remained. Faeces and urine examinations were negative for Pseudonumas aeruginosa. There was no ear suppuration. The identification of the germ was through its property to produce the characteristic pigment and by the following laboratory tests: movement: positive; gelatin: liquefaction; indol: positive; glucose: partial fermentation; lactose, maltose, mannitol and glycerol : no fermentation; peptone broth: surface pellicle and greenish pigment ; blood: hemolysis; V.P.: negative; M.R.: negative; pathogenicity for mice, rats, and guinea-pigs: positive. As far as the authors know this is the first case reported in Brazil. They take the opportunity to present an statistics of the etiological agents of meningitis in the State of São Paulo, from 1945 to 1949.