Co esponding au ho : Salma Hachad
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion License 4.0.
Mixed S ep ococcus pneumoniae and he pes simplex i us meningoencephali is
con i med by PCR: A case epo and e iew o he li e a u e
Salma Hachad *, Inas Ouggane, La i a Ma ih, Mus apha Sodqi, Ahd Ouladlahsen, Fa ima Ihbibane and Kamal
Ma houm El Filali
Depa men o In ec ious Diseases, Ibn Rochd Uni e si y Hospi al Casablanca, Mo occo.
Wo ld Jou nal o Ad anced Resea ch and Re iews, 2025, 26(02), 2579-2582
Publica ion his o y: Recei ed on 02 Ap il 2025; e ised on 10 May 2025; accep ed on 12 May 2025
A icle DOI: h ps://doi.o g/10.30574/wja .2025.26.2.1925
Abs ac
This case epo desc ibes a a e and se e e ins ance o meningoencephali is caused by a dual in ec ion wi h
S ep ococcus Pneumoniae (pneumococcus) and He pes Simplex Vi us ype 1 (HSV-1). The pa ien , a p e iously heal hy
53-yea -old woman, was admi ed wi h symp oms o e e , in ense headache, neck s i ness, pho ophobia, omi ing,
o algia, and al e ed consciousness p og essing o seizu es. Lumba punc u e e ealed a u bid ce eb ospinal luid (CSF)
wi h lymphocy ic pleocy osis, low glucose, and high p o ein. G am s aining showed G am-posi i e cocci, and mul iplex
PCR iden i ied bo h S. pneumoniae and HSV-1.
Despi e ea ly ea men wi h ce iaxone, acyclo i , co icos e oids, and suppo i e ca e, he pa ien 's condi ion
de e io a ed, wi h neu ological decline and espi a o y dis ess necessi a ing in ensi e ca e. Imaging showed bila e al
pulmona y consolida ion bu no ocal b ain lesions. Follow-up CSF analysis showed imp o emen , hough he clinical
condi ion equi ed ongoing c i ical suppo .
This case highligh s he diagnos ic and he apeu ic challenges o co-in ec ions in he cen al ne ous sys em. Dual
bac e ial- i al meningoencephali is is a e bu associa ed wi h high mo bidi y and mo ali y. Ea ly and accu a e
diagnosis ia mul iplex PCR and a mul idisciplina y managemen app oach, including an imic obial and an i i al
he apy along wi h in ensi e suppo i e ca e, a e c i ical o imp o ing ou comes. Long- e m neu ological moni o ing is
ecommended due o he isk o las ing complica ions.
Keywo ds: Meningoencephali is; PCR; Pneumococcus; HSV
1. In oduc ion
Meningoencephali is is a se ious condi ion esul ing om in lamma ion o he meningeal memb anes and b ain
pa enchyma. When caused by dual pa hogen in ec ions, his condi ion becomes e en mo e complex o manage. We
epo he e he case o a pa ien admi ed o he In ec ious Diseases Depa men wi h meningoencephali is caused by
wo ge ms: S ep ococcus Pneumoniae (pneumococcus) and He pes Simplex Vi us ype 1 (HSV-1). This associa ion was
con i med by mul iplex PCR in he ce eb ospinal luid (CSF), and he pa ien p esen ed a apid de e io a ion in he
clinical condi ion, ma ked by consciousness diso de s and espi a o y dis ess, equi ing ans e o in ensi e ca e.
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2. Clinical case
A 53-yea -old woman, N. N., wi h no p e ious medical his o y o no e, was admi ed o he in ec ious diseases
depa men on suspicion o meningi is. He symp oms included pe sis en e e , in ense headache, pho ophobia,
omi ing, s i neck and ea ache, agg a a ed by con usion and con ulsions. All o his had been e ol ing o a week .
Clinical examina ion on admission e ealed a eb ile pa ien a 38.5°, achyca dic, polypneic, oxygen sa u a ion in ee
ai 90%, Glasgow Coma Scale (GCS) sco e 13/15, meningeal s i ness, posi i e Ke ning sign, posi i e B udzinski sign,
muscle s eng h o he igh uppe limb 2/5 and igh lowe limb 3/5, p esence o labial lesions.
A lumba punc u e was pe o med, showing cloudy ce eb ospinal luid (CSF) wi h p edominan ly lymphocy ic
hype cellula i y (290 cells/mm³), hypoglyco hachia (0.05 g/L), and hype p o eino hachia (12 g/L). G am s aining
e ealed G am-posi i e cocci, and mul iplex PCR on he CSF iden i ied S ep ococcus Pneumoniae and He pes Simplex
Vi us ype 1 (HSV-1). CT b ain imaging showed no ocal abno mali ies, and ches CT showed bila e al pos e obasal
pulmona y pa enchymal condensa ion oci, wi h a igh pleu al luid e usion. HIV se ology was nega i e and he CBC
showed HB:13.5, WBC:12800 wi h PNN, PLQ: 271000, ib inogen: 7.3, CRP: 29, ESR: 113, c ea inine: 7.6, u ea: 0.6,
kalaemia: 3.6, na aemia: 168, AST:119, ALT:126, glycaemia: 1.5 .
The pa ien was ea ed wi h ce iaxone (3g wice daily), acyclo i (10mg/kg e e y 8 hou s), in a hecal
co icos e oids.
Con ol lumba punc u e showed clea CSF, wi h cellula i y o less han 3 cells/mm³, hypoglyco hachia (0.15 g/L), and
hype p o eino hachia (1.4 g/L), s e ile cul u e, and no maliza ion o hepa ic cy olysis and blood ionog am.
A e 10 days in hospi al, she was ans e ed o he in ensi e ca e uni , due o neu ological wo sening and espi a o y
dis ess .
3. Discussion
Meningoencephali is is a se ious condi ion, o en associa ed wi h high mo bidi y and mo ali y, pa icula ly when
caused by mul iple pa hogens. The case p esen ed he e, a meningoencephali is wi h dual in ec ion by S ep ococcus
Pneumoniae (pneumococcus) and He pes Simplex Vi us (HSV), con i med by mul iplex PCR in he ce eb ospinal luid
(CSF), illus a es he complexi y o managing hese mul i ac o ial in ec ions. This clinical si ua ion is a e bu po en ially
ca as ophic, equi ing a apid, mul idisciplina y app oach o diagnosis and ea men .
The coexis ence o bac e ial and i al in ec ion in he cen al ne ous sys em (CNS) is a e bu possible, pa icula ly in
immunocomp omised pa ien s o hose wi h speci ic isk ac o s. Combined pneumococcal and HSV
meningoencephali is is ela i ely a e, bu has been epo ed in he li e a u e [1,2], and ep esen s a majo diagnos ic
and he apeu ic challenge.
Pneumococcus can cause pu ulen meningi is, pa icula ly in young child en and olde adul s, wi h a classic pic u e o
e e , headache and nuchal igidi y, accompanied by ocal neu ological signs in se e e o ms [3]. A he same ime, HSV-
1, a neu o opic i us, can be esponsible o he pe ic encephali is, a condi ion ha leads o consciousness diso de s
and p og essi e neu ological de ici s [4 .]
In his case, mul iplex PCR enabled simul aneous iden i ica ion o S. pneumoniae and HSV in CSF, unde lining he
impo ance o molecula echniques in he apid and accu a e diagnosis o CNS in ec ions [5]. Mul iplex PCR has become
an essen ial ool o educing he ime o diagnosis and apidly ini ia ing app op ia e ea men [6,7].
The diso de s o consciousness obse ed in his pa ien a e common in se e e meningoencephali is, whe he bac e ial
o i al in o igin [8]. These diso de s may esul om ce eb al oedema, di ec in lamma ion o he ce eb al pa enchyma
o he e ec o bac e ial oxins [9]. Respi a o y dis ess may be seconda y o b ain s em in ol emen , pneumococcal-
associa ed pneumonia o sys emic decompensa ion due o sepsis [10.]
T ans e o in ensi e ca e was essen ial in his se ing, gi en he se e i y o he clinical condi ion .
Ini ial empi ical an ibio ic ea men o bac e ial meningi is includes hi d-gene a ion cephalospo ins and ancomycin,
wi h he aim o co e ing pneumococcus and o he esis an pa hogens [11]. Fo HSV, an i i al ea men wi h acyclo i
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o alacyclo i is ecommended o se e e o ms o he pe ic encephali is [4]. The use o adju an co icos e oids in
bac e ial meningi is emains con o e sial, bu may be conside ed in some cases o educe b ain in lamma ion [9].
In ou pa ien 's case, combined an ibio ic and an i i al ea men was s a ed as soon as co-in ec ion was suspec ed.
Respi a o y suppo and in ensi e ca e we e essen ial o s abilize he condi ion. Resusci a ion managemen
mechanisms included mechanical en ila ion, neu ocogni i e moni o ing and managemen o in ec ion- ela ed
complica ions .
The p ognosis o dual-in ec ion meningoencephali is is gene ally gua ded, due o he se e i y o b ain damage and
sys emic complica ions. Cases o co-in ec ion wi h bac e ial and i al agen s gene ally ha e a poo e p ognosis, wi h a
high isk o long- e m neu ological sequelae [2]. Long- e m neu ological ollow-up is essen ial o assess po en ial
sequelae, such as cogni i e de ici s, mo o diso de s o epilepsy [12]. The espi a o y complica ions obse ed in ou
pa ien , oge he wi h pe sis en consciousness diso de s, sugges a di icul p ognosis. Howe e , p omp and
app op ia e managemen emains essen ial o imp o e he chances o eco e y.
4. Conclusion
This case illus a es he diagnos ic and he apeu ic complexi y o meningoencephali is caused by co-in ec ion wi h
S ep ococcus Pneumoniae and HSV. I also highligh s he impo ance o mul iplex PCR o apid and accu a e diagnosis.
App op ia e mul idisciplina y managemen in he in ensi e ca e uni , combining an ibio ics and an i i als, and close
moni o ing o neu ological and sys emic complica ions, is c ucial o imp o ing pa ien p ognosis.
Compliance wi h e hical s anda ds
Disclosu e o con lic o in e es
No con lic o in e es o be disclosed.
S a emen o in o med consen
In o med consen was ob ained om all indi idual pa icipan s included in he s udy.
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