A Case report of Methicillin-resistant Staphylococcus aureus meningitis and brain abscess following Dengue fever

ABSTRACT

We report a case of 19-year-old female patient with methicillin-resistant Staphylococcus aureus (MRSA) meningitis and bacteremia. The patient had a prior history of good health. There were many cases of dengue fever around her residential area. The initial symptoms were fever, muscle and joint pain all over the body. On day 4 of illness, she went to a private clinic and was diagnosed with dengue fever. On day 6 of illness, she developed impaired consciousness and was admitted to a provincial hospital then transferred to Bach Mai Hospital on day 9 of illness. Blood culture and cerebrospinal fluid culture were both positive for MRSA. She was treated with continuous Vancomycin infusion, maintaining vancomycin levels in blood of 21-27 mcg/mL but without clinical improvement. Blood and cerebrospinal fluid cultures remained MRSA positive after 5 days of treatment. Combination therapy of continuous vancomycin infusion and intravenous Linezolid together with oral Cotrimoxazole resulted in clinical improvement and negative cerebrospinal fluid culture.

Keywords: Methicillin-resistant Staphylococcus aureus, meningitis, bacteremia.

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