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Year : 2004  |  Volume : 22  |  Issue : 2  |  Page : 130

Bacterial meningitis due to Streptococcus milleri

Department of Microbiology, MKCG Medical College, Berhampur - 760 004, Orissa, India

Correspondence Address:
Department of Microbiology, MKCG Medical College, Berhampur - 760 004, Orissa, India

How to cite this article:
Padhi S, Mahapatra A, Pattnaik D, Chayani N, Mishra S, Mahapatra A. Bacterial meningitis due to Streptococcus milleri. Indian J Med Microbiol 2004;22:130

How to cite this URL:
Padhi S, Mahapatra A, Pattnaik D, Chayani N, Mishra S, Mahapatra A. Bacterial meningitis due to Streptococcus milleri. Indian J Med Microbiol [serial online] 2004 [cited 2020 Nov 24];22:130. Available from:

Dear Editor,
In recent years viridans streptococci have been implicated in the production of abscesses and other purulent infections in internal organs.[1] Among the viridans streptococci, Streptococcus milleri comprising a group of organisms- S. constellatus, S. intermedius and S. anginosus, has been reported to cause endocarditis, intra-abdominal, pulmonary, CNS and oral infections. However, it remains an uncommon cause of meningitis.[2] In this report we describe a case of meningitis due to S. milleri.
A 5 year old boy presenting with complaints of fever, vomiting and two bouts of generalized convulsions was clinically diagnosed as a case of meningitis. Routine investigations revealed no abnormality except raised TLC (12,400/cmm) with polymorphonuclear predominance. Under aseptic conditions, blood and CSF were drawn and sent for bacteriological study. CSF was also sent for cytological and biochemical analysis. Cytology revealed 197 cells/cmm with neutrophilic predominance. The protein and sugar were 207 mg/mL and 6 mg/mL respectively. Centrifuged deposit of the CSF was inoculated to blood agar, chocolate agar and MacConkey agar plates and incubated in a candle jar at 37C. Gram stain of the deposit revealed polymorphonuclear cells and short chains of gram positive cocci. The supernatant was tested by latex agglutination test kit to rule out pneumococci. After overnight incubation, blood agar and chocolate agar plates revealed minute, gray, domed, smooth, -hemolytic colonies and no growth on MacConkey agar. Colonies from both the media were gram positive cocci in short chains and catalase negative. Pneumococci and enterococci were excluded by their resistance to optochin and failure to grow on MacConkey agar respectively. Thus streptococci were considered. The isolate was provisionally identified as S. milleri by inability to ferment sorbitol and positive reactions in Voges-Proskauer and arginine hydrolysis test. The same organism was isolated from the blood culture. Empirical treatment with penicillin and gentamicin was replaced by intravenous ceftriaxone 250 mg 12 hourly after getting the sensitivity report and was continued for one week. The patient improved clinically on fourth day of therapy.
The S. milleri group of organisms are part of the normal oropharyngeal flora, GI tract and vagina. When isolated from such sites they are generally regarded as commensals and not tested further, however, when found in pure culture from blood, CSF, abscess or other closed lesions, they are likely to have a pathogenic role, their antibiotic sensitivity should then be tested and reported.[3] 

 ~ References Top

1.Gossling J. Occurrence and pathogenesis of the Streptococcus melleri group. Rev Infect Dis 1988;10:257.  Back to cited text no. 1    
2.Barbara AB, Norman TB, Stephen HG. (Eds) Infections of the Central Nervous System, Chapter 16. In: Infectious Disease, 1st ed. (Black Well Science Ltd., Oxford) 1996:323.  Back to cited text no. 2    
3.Ross PW. Streptococcus and Entercoccus, Chapter 12. In: Mackie & McCatrney practical Medical Microbiology, 14th ed. Colle JG, Fraser AG, Marmion BP, Simmons A, Eds (Churchill livingstone, New York) 1996:268.  Back to cited text no. 3    
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2004 - Indian Journal of Medical Microbiology
Published by Wolters Kluwer - Medknow

Online since April 2001, new site since 1st August '04