Klebsiella ozaenae meningitis: report of two cases and review of the literature.

Meningitis is rarely caused by Klebsiella ozaenae, a colonizer of the oral and nasopharyngeal mucosa. We describe two patients with K. ozaenae meningitis. Both patients suffered from a primary disease of the nasopharyngeal pathway; one had nasopharyngeal carcinoma and the other ozena. Review of the English-language literature from 1966 to the present revealed only two cases of K. ozaenae meningitis; pneumonia and hyperglycemia were noted in one patient and otitis media, sinusitis and diabetes mellitus in the other. All these four patients were over 50 years old. Of the four patients, two treated with third-generation cephalosporins recovered whereas one of the two treated with chloramphenicol died. One patient who died had a positive blood culture for K. ozaenae. Blood culture was positive in only one of the three survivors. Whether chloramphenicol should be replaced by a third-generation cephalosporin and whether blood culture indicates a poor prognosis in K. ozaenae meningitis remain to be determined.