Meningoencefalitis por Herpes simplex virus 1 y Streptococcus pneumoniae en Pediatría. Reporte de caso

Introduction: meningoencephalitis is an infection that compromises meninges and brain parenchyma. Its clinical expression varies from nonspecific symptoms, to signs of meningeal irritation of acute onset and with fatal results. Co-infection of bacteria and viruses is rare. The start of antibiotic treatment is empirical; the etiological identification by molecular methods allows specific management. Objective: To describe the clinical case of a school-age patient with meningoencephalitis, with rapidly progressive neurological involvement, and lethal, in which coinfection was identified between Human Herpes Virus type 1 (HSV1) and Streptococcus pneumoniae serotype 14 in cerebrospinal fluid (CSF). Clinical case: Female patient of 8 years of age, with no history of previous hospitalizations, admitted to the emergency department with headache, fever and emesis of 12 hours of evolution. He presents rapidly progressive neurological deterioration, with CSF study with characteristics of infection of the central nervous system (CNS) and identification of HSV1 and Streptococcus pneumoniae serotype 14 by polymerase chain reaction (PCR) and Quellung reaction, for which he received acyclovir, Ceftriaxone, vancomycin. We identified hypogammaglobulinemia G, M, lymphopenia, C3 complement decreased for age. The patient presents brain death at 20 hours of clinical evolution, and subsequently dies. Conclusions: meningoencephalitis can have clinical manifestations of sudden onset, rapidly progressive and with fatal outcomes despite adequate treatment. In this patient, the coinfection of HSV1 and Streptococcus pneumoniae serotype 14 was identified, which, together with the immunological anomalies, could be related to its severe involvement.Introduction: meningoencephalitis is an infection that compromises meninges and brain parenchyma. Its clinical expression varies from nonspecific symptoms, to signs of meningeal irritation of acute onset and with fatal results. Co-infection of bacteria and viruses is rare. The start of antibiotic treatment is empirical; the etiological identification by molecular methods allows specific management. Objective: To describe the clinical case of a school-age patient with meningoencephalitis, with rapidly progressive neurological involvement, and lethal, in which coinfection was identified between Human Herpes Virus type 1 (HSV1) and Streptococcus pneumoniae serotype 14 in cerebrospinal fluid (CSF). Clinical case: Female patient of 8 years of age, with no history of previous hospitalizations, admitted to the emergency department with headache, fever and emesis of 12 hours of evolution. He presents rapidly progressive neurological deterioration, with CSF study with characteristics of infection of the central nervous system (CNS) and identification of HSV1 and Streptococcus pneumoniae serotype 14 by polymerase chain reaction (PCR) and Quellung reaction, for which he received acyclovir, Ceftriaxone, vancomycin. We identified hypogammaglobulinemia G, M, lymphopenia, C3 complement decreased for age. The patient presents brain death at 20 hours of clinical evolution, and subsequently dies. Conclusions: meningoencephalitis can have clinical manifestations of sudden onset, rapidly progressive and with fatal outcomes despite adequate treatment. In this patient, the coinfection of HSV1 and Streptococcus pneumoniae serotype 14 was identified, which, together with the immunological anomalies, could be related to its severe involvement.Keywords: Meningitis, Encephalitis, Streptococcus   pneumoniae, Herpesvirus 1, Human, Meningoencephalitis.IntroduccionLa meningoencefalitis es un proceso inflamatorio del Sistema nervioso central que afecta las meninges y el parenquima cerebral. Su incidencia es mayor en la edad infantil. En los escolares se manifiesta con cefalea, fiebre, vomitos, alteraciones en el estado de conciencia y en algunos, puede tener compromiso neurologico severo y progresivo. El Streptococcus pneumoniae es el principal agente causal de la meningitis y el Herpes simplex virus 1 de las encefalitis1,2, su coinfeccion no es frecuente3. La evaluacion clinica y diagnostica de cada paciente debe basarse en la historia clinica, estudios del LCR, pruebas moleculares como la reaccion en cadena de polimerasa, y ayudas imagenologicas en caso de ser necesarias4,5. Se debe dar tratamiento inicialmente empirico y posteriormente dirigido1,2. Se describe el caso de un paciente en edad escolar con meningoencefalitis, con compromiso neurologico rapidamente progresivo y letal, con coinfeccion entre HSV1 y Streptococcus pneumoniae.