{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T08:47:54Z","timestamp":1759826874072,"version":"build-2065373602"},"reference-count":19,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:00:00Z","timestamp":1759795200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.mdpi.com"],"crossmark-restriction":true},"short-container-title":["Microorganisms"],"abstract":"<jats:p>Pneumococcal meningoencephalitis is a severe infection associated with high morbidity and mortality. Although typically community-acquired, postoperative cases following elective ENT surgery are exceedingly rare. Antimicrobial resistance (AMR) among Streptococcus pneumoniae further complicates management, and missed opportunities for vaccination represent preventable risks. We report a case of a 41-year-old man with multiple comorbidities who developed fulminant S.\u00a0pneumoniae meningitis 48 h after septoturbinoplasty. The clinical course was atypical, with altered consciousness but no classical meningeal signs, necessitating urgent intubation and intensive care admission. Cerebrospinal fluid cultures identified an MDR pneumococcal strain resistant to penicillin and macrolides but susceptible to vancomycin and meropenem. Empirical therapy with vancomycin and meropenem, combined with adjunctive corticosteroids and multidisciplinary ICU care, led to complete neurological recovery. This case highlights a rare but life-threatening postoperative complication and underscores two critical lessons. First, the growing challenge of multidrug-resistant pneumococcus requires timely recognition, aggressive empiric therapy, and access to effective agents. Second, the absence of pneumococcal vaccination in this high-risk surgical patient illustrates a preventable gap in care. Integrating vaccination screening into preoperative evaluations may reduce the risk of catastrophic postoperative CNS infections.<\/jats:p>","DOI":"10.3390\/microorganisms13102315","type":"journal-article","created":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T08:05:36Z","timestamp":1759824336000},"page":"2315","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Fulminant Multidrug-Resistant Streptococcus pneumoniae Meningoencephalitis After Elective ENT Surgery: A Case Report"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-8818-9539","authenticated-orcid":false,"given":"Corina-Ioana","family":"Anton","sequence":"first","affiliation":[{"name":"Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Bvd, 050474 Bucharest, Romania"},{"name":"Department of Medico-Surgical and Prophylactic Disciplines, Titu Maiorescu University, 040441 Bucharest, Romania"},{"name":"Department of Infectious Diseases, \u201cDr. Carol Davila\u201d Central Military Emergency University Hospital, 134 Calea Plevnei, 010242 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Madalina Maria","family":"Zamfir","sequence":"additional","affiliation":[{"name":"Faculty of General Medicine, Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Bvd, 050474 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandru","family":"Ghi\u021b\u0103","sequence":"additional","affiliation":[{"name":"Medical Informatics Office, Telemedicine, Communications and Information Technology Agency, 134 Calea Plevnei, 010242 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5398-3210","authenticated-orcid":false,"given":"Mihaela Raluca","family":"Mititelu","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, University of Medicine and Pharmacy Carol Davila, 020021 Bucharest, Romania"},{"name":"Department of Nuclear Medicine, University Emergency Central Military Hospital, 010825 Bucharest, Romania"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"6160","DOI":"10.1016\/j.vaccine.2017.09.050","article-title":"Trends in pneumococcal meningitis hospitalizations following the introduction of the 13-valent pneumococcal conjugate vaccine in the United States","volume":"35","author":"Jacobs","year":"2017","journal-title":"Vaccine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1111\/joim.13488","article-title":"Bacterial meningitis: Aetiology, risk factors, disease trends and severe sequelae during 50 years in Sweden","volume":"292","author":"Block","year":"2022","journal-title":"J. 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Infect."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2018\/7292084","article-title":"NOD2 expression in streptococcus pneumoniae meningitis and its influence on the blood-brain barrier","volume":"2018","author":"Wang","year":"2018","journal-title":"Can. J. Infect Dis. Med. Microbiol."},{"key":"ref_7","unstructured":"European Centre for Disease Prevention and Control (ECDC) (2024). Invasive Pneumococcal Disease\u2014Annual Epidemiological Report for 2023, ECDC."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Tabusi, M., Thorsdottir, S., and Lysandrou, M. (2021). Neuronal death in pneumococcal meningitis is triggered by pneumolysin and RrgA interactions with \u03b2-actin. PLoS Pathog., 17.","DOI":"10.1371\/journal.ppat.1009432"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Too, L.K., Yau, B., and Baxter, A.G. (2019). 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