Meningitis with vancomycin-tolerant Streptococcus pneumonia: a case report in the northeast of Iran

Meningitis is a clinical syndrome that occurs for a variety of reasons such as bacterial infections. Acute bacterial meningitis can occur at any age, and is a leading cause of mortality worldwide. Streptococcus pneumonia is a bacterial meningitis that can lead to pneumococcal meningitis, especially in children. In recent decades, the percentage of pneumococcal strains resistant to penicillin and cephalosporins isolated from children has increased. This has made vancomycin the first empirical antibiotic therapy for children with suspected bacterial meningitis.In this report, we introduce a 13-month-old child who was brought to the emergency department of Akbar Children’s Hospital, Mashhad (a city in northeastern Iran) with complaints of high-grade fever and drowsiness. Meningitis was diagnosed via sampling of cerebrospinal fluid, and the culture indicated S. pneumonia that was non-sensitive to vancomycin. The e-test and microdilution have been approved to determine the minimum inhibitory concentration (MIC) of vancomycin; however, the e-test is a more straightforward method and the error probability is less while providing similar results to microdilution. Also, both methods can predict vancomycin tolerance or reduce sensitivity to vancomycin. Results of the e-test indicate MIC=2.