• Andrei Vâţă, Erika Irimie-Băluţă, Florin Manuel Roşu, Ioana Maria Onofrei, Isabela Ioana Loghin, Mihaela Perţea, Andrei Nicolae Avădanei, Mihnea Miron, Luminiţa Rădulescu, Irina Eşanu, and Cătălina Mihaela Luca.
• Department of Infectious Diseases, "Grigore T. Popa" University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania.
• Medicina (Kaunas). 2023 Aug 7; 59 (8).

AbstractPolymicrobial meningitis is a rare entity in the adult population, especially in the antibiotic era. However, disorders such as chronic suppurative otitis media (CSOM) or even poor oral hygiene are considered risk factors for the development of such cerebral infection. We report a case of polymicrobial meningitis associated with oto-mastoiditis in a 64-year-old female patient known to have CSOM. The patient presented atypical symptoms for community-acquired meningitis, showing subacute evolution of headache, without fever or neck stiffness. The aerobe microorganisms Streptococcus anginosus and Corynebacterium spp., sensitive to beta-lactamines, and the anaerobe Prevotella spp., resistant to penicillin and metronidazole, were isolated from CSF specimens, while Proteus mirabilis and Enterococcus faecalis were identified from the ear drainage. The diversity of pathogens identified in our case led us to the hypothesis of two different sources of meningitis: otogenic and/or odontogenic. Favorable evolution was obtained after a multi-disciplinary approach, combining surgery and broad-spectrum antibiotics. In addition, we performed a literature review that highlights the low incidence of polymicrobial mixed aerobe-anaerobe meningitis.

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