Unusual Coinfection of Central Nervous System

Author(s): Arantxa Berzosa Sánchez, Marta Illán Ramos, Esther Culebras, José Tomás Ramos Amador

Central nervous system infections may encompass a wide spectrum of manifestations from meningitis, if only meningeal inflammation is presented, to encephalitis, if the parenchyma is involved, although frequently both are affected leading to meningoencephalitis. Mainly caused by viruses, bacterial origin should always be ruled out because of its worse prognostic. An adolescent of 13-years-old is presented, who complained of fever, psychomotor agitation and altered level of consciousness of sudden onset. Once the diagnosis of meningoencephalitis was suspected samples from blood and cerebrospinal-fluid (CSF) were collected, and antibiotics were started. After 24 hours Neisseria meningitidis was isolated in blood culture and Human Herpesvirus 6 was detected by PCR in CSF, receiving treatment against both pathogens (cefotaxime and ganciclovir) with a prompt recovery. Even when bacterial and virus coinfection is not a common finding in CNS infections, it may occur, with high impact on clinical evolution of the patient. In order to stablish an accurate microbiological diagnosis, appropriate samples should be taken. It is also important to remark that treatment should be adjusted accordingly to microbiological results.