Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Label_Title

Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Label_Title

Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Kocuria kristinae Meningoencephalitis: Case Report - Literature Review

Nada Barkia, Khouloud Mnif*, Hana Chaabouni, Yoldez Ben Jemaa, Tarak Ben Jemaa, Amira Trigui, Mounir Ben Jemaa

Infectious diseases department.Hedi Chaker Hospital, Sfax, Tunisia

Abstract: Kocuria (K) kristinae is a rare pathogen, with only a few reported cases, predominantly in immunocompromised patients and occasionally in immunocompetent individuals. This report presents a case of K.kristinae meningoencephalitis in 34-year-old man undergoing neurosurgery for a type 1 Arnold Chiari malformation with a ventriculoperitoneal shunt. The patient developed fever and epileptic seizures, prompting an etiological investigation, including lumbar puncture and the CSF was clear, 140 leukocytes/mL with 40% neutrophil polynuclear and 60% lymphocyte, increased proteinorachy to 0.61g/L and hypoglucorachy to 0.59 mmol/L, with a positive culture for K. Kristinae. The patient received 45 days of antibiotic therapy with meropenem and vancomycin.Despite treatment, the patient succumbed to progressive neurological deterioration.

Keywords: Kocuria kristinae, meningoencephalitis, rare

Received November 20, 2025; Revised December 22, 2025; Accepted December 28, 2025

Citation: Nada Barkia, Khouloud Mnif, Hana Chaabouni, Yoldez Ben Jemaa, Tarak Ben Jemaa, Amira Trigui, Mounir Ben Jemaa, Kocuria kristinae Meningoencephalitis: Case Report - Literature Review. American Journal of Medical Case Reports, 13 (12). 88-90. January 2025. doi:10.12691/ajmcr-13-12-2

1. Introduction

Kocuria(K) are Gram-Positive cocci actinobacteria found in tetrads belonging to the family Micrococcaceae, suborder Micrococcineae, order Actinomycetales [1]. It is a normal skin flora that can be associated with urinary tract infections and have been isolated from other bodily fluids like CSF [2]. We report the case of a young man with a neurological malformation presenting with K.Kristinae meningoencephalitis.

2. Case Report

A 34-year-old man is undergoing neurosurgery for a type 1 Arnold Chiari malformation with a ventriculoperitoneal shunt. He presented with fever and epileptic seizures. Clinical examination revealed a disturbance of consciousness, no sensory or motor deficits, and valve dysfunction (regurgitation). Laboratory tests showed lymphopenia at 700/mm3 (normal range >1500), C-reactive-protein at 110mg/L (normal range <5), and negative procalcitonin at 0.12 ng/mL (normal range <0.5 ng/mL). Hepatic and renal function tests were normal.

A thoracic CT scan for an infectious focus has been performed, showing multiple confluent alveolar nodules in the middle lobe. A cerebral CT scan showed significant quadriventricular dilatation, discrete signs of transependymal resorption, and herniation of the cerebellar tonsils through the foramen magnum. The eye fundus was normal. As part of the etiological investigation, a lumbar puncture was performed, the cerebrospinal fluid (CSF) was clear on macroscopic examination. The CSF formula revealed 140 leukocytes/mL with 40% neutrophil polynuclear and 60% lymphocyte, increased proteinorachy to 0.61g/L and hypoglucorachy to 0.59 mmol/L. Microbiological culture showed a positive culture for K. Kristinae, sensitive to gentamycin, rifampicin and vancomycin, with resistance to fosfomycin. Standard blood culture isolated the same germ. PCR for Koch's bacillus on CSF was negative. HIV serology was negative. The patient was treated with meropenem, vancomycin, and rifampicin. At 7 days, he underwent an external ventricular bypass (EVB). Biological monitoring showed C-reactive protein at 31mg/L. A follow-up lumbar puncture after 21 days showed 1 leukocyte/mL with a negative culture. In total, the patient received 45 days of antibiotic therapy with meropenem and vancomycin (rifampicin stopped on the 17th day). Neurological worsening marked the clinical course, from which he benefited from the removal of the EVB and a cerebral MRI showing cystic dilatation of ventricle 3. Antibiotic therapy was switched to clindamycin and teicoplanin with a biological control showing a C-reactive protein of 0.8mg/L, from which he benefited from DVP placement. A lumbar puncture was performed the same day showing a leukocyte count of 35/mL. Antibiotic therapy with vancomycin and rifampicin was reintroduced the same day after stopping. The evolution was marked by an initial clinical and biological improvement within a week of DVP placement. On day 10 of the DVP break, the patient's neurological status deteriorated, with a cerebral CT scan showing pneumocephalus with intraoccipital hemorrhage of the lateral ventricle. The patient was admitted to the intensive care unit, intubated and ventilated, and died after 24 hours.

3. Discussion

K. kristinae, first described in 1974, is a natural commensal of the skin and mucosal flora in several mammals, but it acts as an opportunistic pathogen. Among the 18 recognized species within the genus Kocuria, five are known to be pathogenic. [3]. K. kristinae is facultative anaerobic, nonmotile, catalase-positive, and coagulase-negative and is known to cause catheter-related bacteremia and infective endocarditis [4,5]. In a narrative review, the most frequently reported types of infection were bacteremia, skin and soft tissue infection, endophthalmitis, infectious endocarditis, and peritonitis [5]. Additionally, a search of the PubMed biomedical database identified eight documented cases of K. kristinae isolation in CSF (eg.meningitidis, encephalitis,…) in a review of the literature (Table 1). K.kristinae meningoencephalitis are most commonly observed in patients with immunosuppression, deformities, those undergoing critical care, or even neonates; however, an increase in Kocuria meningoencephalitis has lately been noted in immunocompetent individuals [12]. Kocuria spp. constitutes part of normal human flora and can be isolated from various environmental niches. More specifically, these pathogens inhabit human skin and mucus membranes, such as the oral cavity, and are usually considered non-pathogenic. So far, microbiology laboratories have treated these bacteria as contaminants, leading to the underdiagnosis of Kocuria spp. Infections [13]. The spectrum of pathology requires a high index of suspicion and extensive microbiological testing to make a diagnosis [2]. The most common method of K. kristinae identification was biochemical phenotyping,which detected the microorganism in approximately 75% of cases [14]. Most data point toward the organism being pan sensitive to mulitple antibiotics [15]. In fact, susceptibility of K.kristinae was highest to vancomycin, linezolid, rifampicin, teicoplanin, tigecycline, cefotaxim, ampicillin/sulbactam, minocycline and meropenem, while the highest resistance rate K.kristinae showed to penicillins, gentamycin and erythromycin [14]. Protocols regarding the ideal antimicrobial treatment of Kocuria spp. meningoencephalitis still need to be clearly defined. According to the data in the narrative review [5], vancomycin could be the agent of choice for neuromeningeal infections where pathogen identification is suggestive for Kocuria spp. until antimicrobial susceptibility results are available. The mortality rate of meningoencephalitis caused by Kocuria spp. was relatively low [5].

4. Conclusion

K.kristinae has a significant pathogenic potential to cause invasive infections of various organs in patients of any age. Vancomycin is the preferred empirical treatment for K.kristinae meningitis or encephalitis until antimicrobial susceptibility testing is completed. The severity and prognosis of these infections correlate with the patient’s immune state. Early clinical and microbiological intervention and appropriate antibiotic therapy are crucial for managing these infections.

Table 1. Main characteristics of the studies that isolated of K. kristinae in CSF

Declarations

Ethics approval and consent to participate: done

Clinical Trial: not applicable

Consent for publication: done

Availability of data and material: yes available

Competing interests: no

Funding: no

Authors' contributions: NB, KM, HC, YBJ, TBJ, AT, MBJ

Acknowledgements: yes, done

References

[1]   | Stackebrandt E, Koch C, Gvozdiak O, Schumann P. Taxonomic dissection of the genus Micrococcus: Kocuria gen. nov., Nesterenkonia gen. nov., Kytococcus gen. nov., Dermacoccus gen. nov., and Micrococcus Cohn 1872 gen. emend. Int J Syst Bacteriol. 1995; 45(4): 682‑92.
[2]   | Napolitani M, Troiano G, Bedogni C, Messina G, Nante N. Kocuria kristinae: an emerging pathogen in medical practice. J Med Microbiol.2019; 68(11): 1596‑603.
[3]   | Hassan RM, Bassiouny DM, Matar Y. Bacteremia Caused by Kocuria kristinae from Egypt: Are There More? A Case Report and Review of the Literature. Case Rep Infect Dis. 2016; 6318064.

[4]  
Lai CC, Wang JY, Lin SH, Tan CK, Wang CY, Liao CH, et al. Catheter-related bacteraemia and infective endocarditis caused by Kocuria species. Clinical Microbiology and Infection. 2011; 17(2): 190‑2. Napolitani M, Troiano G, Bedogni C, Messina G, Nante N. Kocuria kristinae: an emerging pathogen in medical practice. J Med Microbiol.2019; 68(11): 1596‑603.

[5]   | Ziogou A, Giannakodimos I, Giannakodimos A, Baliou S, Ioannou P. Kocuria Species Infections in Humans—A Narrative Review. Microorganisms. 2023; 11(9): 2362.
[6]   | Ali FA, Al-Daood AAK, Burhan PK, Tofiq LR, Shakur PS. The Incidence of Multirsistance Kocuria spp. among Different Clinical Samples in Erbil City, Iraq. SAJRM. 2022; 34‑44.
[7]   | Tajane SB, Vaidya AS, Bhalerao DS, Roushani SB, Kulkarni SG, Rajhans AV, et al. Culture Positivity of Cerebrospinal Fluid by Automated Blood Culture System in Neonates: A Cross-sectional Study from Loni, Maharashtra, India. Journal of Clinical and Diagnostic Research. 2022; 16(1): DC06-DC09.
[8]   | Amina W, Omar Y, Nesrine J, Ahmed R, Raoudha B, Mohamed K, et al.Kocuria Kristinae Meningitis and Cranial Nerve Palsies Secondary to Sphenoid Sinusitis: About a Case. AJP. 2021; 7(3): 159.
[9]   | Biswal D, Kaur R, Satija S, Seth A, Rathi A, Kant L. The expanding spectrum of human infections causes by Kocuria species in paediatric patients: one year observational, prospective hospital based study.. International Journal of Infectious Diseases. 2023; 130: S64.
[10]   | Kumar PA, Chougale RA. Kocuria kristinae (Unusual Pathogen) Isolated from Cerebrospinal Fluid: A Case of Acute Meningitis. JMSCR. 2021; 15: 93‑7.
[11]   | Saldaña-Ruiz MA, Chávez-García JM, Ortiz-Alonso F, Ortiz-Arce CS, Espinosa-Mora JE, Cortés-Cárdenas JR. Kocuria kristinae neuroinfection in an immunocompetent patient: a case report and review of the literature. IJID Regions. 2023; 9: 117‑9.
[12]   | Dotis J, Printza N, Papachristou F. Peritonitis Attributable to Kocuria rosea in a Pediatric Peritoneal Dialysis Patient. Perit Dial Int. 2012; 32(5): 577‑8.
[13]   | Kandi V, Palange P, Vaish R, Bhatti AB, Kale V, Kandi MR, et al. Emerging Bacterial Infection: Identification and Clinical Significance of Kocuria Species. Cureus. 2016; 8(8): e731.
[14]   | Živković Zarić RS, Pejčić AV, Janković SM, Kostić MJ, Milosavljević MN, Milosavljević MJ, et al. Antimicrobial treatment of Kocuria kristinae invasive infections: Systematic review. Journal of Chemotherapy. 2019; 31(3): 109‑19.
[15]   | Tewari R, Dudeja M, Das AK, Nandy S. Kocuria kristinae in catheter associated urinary tract infection: a case report. J Clin Diagn Res. 2013; 7(8): 1692‑3.