Fax +41 61 306 12 34 E-Mail karger@karger.ch www.karger.com Case Report Med Princ Pract 2010;19:235–239 DOI: 10.1159/000285301 A Case of Community-Onset Meningitis Caused by Hospital Methicillin-Resistant Staphylococcus aureus Successfully Treated with Linezolid and Rifampicin M. Al Kandari a W. Jamal a, b E.E. Udo a, b A. El Sayed c S. Al Shammri c V.O. Rotimi a, b a Division of Microbiology, Mubarak Al-Kabir Hospital, and Departments of b Microbiology and c Medicine, Faculty of Medicine, Kuwait University, Kuwait He was treated with intravenous linezolid and rifampicin for 2 weeks, made good response and was discharged home fully recovered and well. Conclusion: Hospital MRSA should be considered in the differential diagnosis of the causative agents of community-onset meningitis in healthy patients even without predisposing factor. Copyright © 2010 S. Karger AG, Basel Introduction Staphylococcus aureus is an uncommon etiological agent of acute bacterial meningitis. Two different mech- anisms of pathogenesis have been described in staphylo- coccal meningitis: postoperative meningitis which is as- sociated with neurosurgical procedures, shunt insertion or head trauma and hematogenous meningitis second- ary to parameningeal infection or staphylococcal infec- tion outside the central nervous system (CNS). Infec- tions caused by methicillin-resistant S. aureus (MRSA) are increasingly prevalent worldwide, particularly in hospital settings. However, MRSA only emerged as a cause of community-acquired MRSA infections in the Key Words Methicillin-resistant Staphylococcus aureus  Meningitis  Linezolid  Rifampicin  Kuwait Abstract Objective: To report a relatively rare presentation of methi- cillin-resistant Staphylococcus aureus (MRSA) meningitis in a previously healthy boy in Kuwait. Clinical Presentation and Intervention: A 14-year-old boy presented with a 2 weeks’ history of headache and fever with increasing severity. He developed photophobia and double vision 2 days prior to his hospital visit and received ceftriaxone for 6 days prior to admission to the hospital. There was no history of head trau- ma or neurosurgical operation. Lumbar puncture revealed a slightly turbid cerebrospinal fluid with pleocytosis and greatly reduced glucose, elevated protein level and on cul- ture grew MRSA. Staphylococcal chromosome cassette mec (SCC mec) typing revealed that it belonged to SCC mec type III and sequence type 238 (ST238-SCC mec-III). Polymerase chain reaction screening for the presence of Panton-Valen- tine leukocidin (PVL) genes yielded a negative result; all these findings were consistent with hospital-acquired MRSA. Received: January 29, 2009 Revised: June 11, 2009 Vincent O. Rotimi, MD, PhD, FRCPath, FWACP Department of Microbiology, Faculty of Medicine, Kuwait University PO Box 24923 13110 Safat (Kuwait) Tel. +965 2489 6509, Fax +965 2533 2719, E-Mail vincent @ hsc.edu.kw © 2010 S. Karger AG, Basel 1011–7571/10/0193–0235$26.00/0 Accessible online at: www.karger.com/mpp