Published online April 10, 2006
PEDIATRICS Vol. 117 No. 5 May 2006, pp. e1061-e1066 (doi:10.1542/peds.2005-1994)
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EXPERIENCE & REASON

Pneumonia and Empyema Caused by Penicillin-Resistant Neisseria meningitidis: A Case Report and Literature Review

Daniel Glikman, MDa, Scott M. Matushek, MSb, Madelyn D. Kahana, MDc and Robert S. Daum, MDa

a Department of Pediatrics, Sections of Infectious Diseases
c Critical Care, University of Chicago, Chicago, Illinois
b Clinical Microbiology Laboratories, University of Chicago Hospitals, Chicago, Illinois

ABSTRACT

Pneumonia is an uncommon manifestation of Neisseria meningitidis infection, and empyema is rarely reported. Uniform penicillin susceptibility has been assumed for meningococcal infections for many years, but decreased penicillin susceptibility has been recognized recently with increasing frequency. Breakpoints to define different categories of susceptibility were published recently by the Clinical and Laboratory Standards Institute. We report the case of a teenage girl with sepsis and extensive bilateral pneumonia with empyema caused by an N meningitidis isolate that was resistant to penicillin. Her protracted clinical course suggested that penicillin resistance contributed to her delayed recovery. Our experience with this patient suggests that susceptibility testing should be performed in every case of N meningitidis isolation, and treatment with a third-generation cephalosporin should be provided until the susceptibility results are known. Clinical suspicion of N meningitidis as a possible cause of respiratory symptoms accompanied by hypotension, even in the absence of a rash, may aid in diagnosis and therefore in the treatment and provision of prophylaxis to contacts of patients with meningococcal disease.

Key Words: Neisseria meningitidis • pneumonia • empyema • penicillin resistance

Abbreviations: CLSI, Clinical and Laboratory Standards Institute • CT, computed tomography • MIC, minimal inhibitory concentration • CDC, Centers for Disease Control and Prevention

Accepted Nov 4, 2005.