Group A Streptococcal Meningitis Research Articles

Group A Streptococcal meningitis in children: a short case series and systematic review.

Group A streptococcal(GAS) meningitis is a severe disease with a high case fatality rate. In the era of increasing GAS meningitis, our understanding about this disease is limited. To gain a better understanding about GAS meningitis. Five new cases with GAS meningitis were reported. GAS meningitis related literatures were searched for systematic review in PUBMED and EMBASE. Case reports and case series on paediatric cases were included. Information on demographics, risk factors, symptoms, treatments, outcomes, and emm types of GAS was summarized. Totally 263 cases were included. Among 100 individuals, 9.9% (8/81) had prior varicella, 11.1% (9/81) had anatomical factors, and 53.2% (42/79) had extracranial infections. Soft tissue infections were common among infants (10/29, 34.5%), while ear/sinus infections were more prevalent in children ≥ 3 years (21/42, 50.0%). The overall case fatality rate (CFR) was 16.2% (12/74). High risk of death was found in patients with shock or systemic complications, young children(< 3 years) and cases related to hematogenic spread. The predominate cause of death was shock(6/8). Among the 163 patients included in case series studies, ear/sinus infections ranged from 21.4 to 62.5%, while STSS/shock ranged from 12.5 to 35.7%, and the CFR ranged from 5.9 to 42.9%. A history of varicella, soft tissue infections, parameningeal infections and CSF leaks are important clinical clues to GAS in children with meningitis. Young children and hematogenic spread related cases need to be closely monitored for shock due to the high risk of death.

Group A Streptococcus Meningitis Following Arnold-Chiari Correction Surgery: A Case Report

Group A Streptococcus (GAS) can cause invasive disease but rarely causes meningitis. Here we report a three-year-old girl with a GAS meningitis after Arnold-Chiari type I corrective surgery. Six days after surgery she presented fever, headache, vomiting and surgical wound inflammatory signs. A cerebrospinal fluid (CSF) collection with a fistulous path to skin was identified and GAS was found in blood and CSF cultures. Despite targeted antibiotherapy, due to lack of improvement and difficult management of the CSF fistula, she needed to be submitted to several surgical corrections and increased antibiotherapy spectrum. Despite the low risk in acquiring bacterial meningitis after neurosurgery, these procedures may be a direct route for infection. Surgery complications like a fistula are a known risk factor for infection and although uncommon, GAS meningitis may be difficult to manage and can cause serious morbidity.

STREPTOCOCCUS PYOGENES: A DEVASTATING CAUSE OF MENINGITIS IN A YOUNG ADULT

SESSION TITLE: Critical Care 1 SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Streptococcus pyogenes is a rare but aggressive cause of bacterial meningitis. CASE PRESENTATION: A 27-year-old healthy gentleman presented to the emergency department with a 3 day history of headache. His symptoms began with an upper respiratory infection and fever which had resolved. Vital signs were normal, but he appeared in mild distress. His neurologic exam was non-focal without nuchal rigidity. There was tenderness to palpation over the right maxillary sinus. A CT head showed paranasal mucosal thickening and air-fluid levels in the right maxillary sinus. He was treated with intravenous fluids, acetaminophen, and promethazine with improvement in his headache. He was discharged home with a diagnosis of sinusitis. Within 24 hours, he returned to the emergency room after he developed confusion and suddenly collapsed. On presentation, he was hypotensive and febrile. His mental status was obtunded. Laboratory studies were notable for a leukocytosis with 55% bands, lactic acidosis, and acute renal failure. A lumbar puncture was performed with an opening pressure of 57 cm of water and had 11,000 white blood cells with 98% neutrophils. He was given dexamethasone, vancomycin, and ceftriaxone. Gram stain of the cerebral spinal fluid revealed gram positive cocci in chains and later grew Streptococcus pyogenes. A repeat CT head showed progression of sinusitis and effacement of the sulci concerning for cerebral edema. In the intensive care unit, he had multiple episodes of cardiac arrest, septic shock requiring vasopressors, and acute respiratory distress syndrome with refractory hypoxemia. On exam, brainstem reflexes were absent and he passed away 34 hours after admission. DISCUSSION: Streptococcus pyogenes, or Group A Streptococcus (GAS), is a rare cause of bacterial meningitis in the United States. In 1985, the incidence of bacterial meningitis due to GAS was 0.2% (1). A review of the literature showed a prospective study in the Netherlands where GAS was the cause of 2% of cases of bacterial meningitis. Of the patients with GAS meningitis, 92% initially presented with otitis media or sinusitis, 52% of patients developed neurologic sequelae, and 19% of the patients died. The most common neurologic complications were subdural empyema and hearing loss, while the most common systemic complications were respiratory failure and septic shock (2). Of note, this patient had preceding upper respiratory symptoms and presented during influenza season. There are reports of increased invasive GAS co-infection with influenza in healthy patients, some of which resulted in death (3). CONCLUSIONS: Although GAS is a rare cause of meningitis, this invasive organism may present with benign features of otitis media or sinusitis, and develop aggressively to meningitis associated with high rates of morbidity and mortality. It is important to consider GAS infection especially during influenza season. Reference #1: Schleck, W. et al. “Bacterial Meningitis in the United States, 1978-1981.” JAMA. 1985; 253(12): 1749-1754. Reference #2: Marjolein, L. et al. “Group A Streptococcal meningitis in adults.” Journal of Infection. 2015; 71(1): 37-72. Reference #3: Jean, C. et al. “Invasive Group A Streptococcal Infection Concurrent with 2009 H1N1 Influenza.” Clinical Infectious Disease. 2010; 50(10): e59-e62. DISCLOSURES: No relevant relationships by Chloe Castro, source=Web Response No relevant relationships by Edward Warren, source=Web Response

Group A streptococcal meningitis: emm type distribution and theoretical vaccine coverage in children

As group A Streptococcus (GAS) meningitis is seldom reported in children, emm-type distribution data are scare. We report eight cases of GAS meningitis in Belgium (2008–2013) and compare molecular characteristics of our strains with a further 55 cases previously reported with their corresponding emm-types. emm1 type was the most frequent (24%) followed by emm6 (11%), emm12 (11%) and emm3 (6%). Together these four emm-types accounted for 52% of the cases, while the rest of the cases are due to 24 different emm-types. These 28 emm-types associated with GAS meningitis belonged to 16 different emm-clusters suggesting that there is no propensity for particular emm-types or emm-cluster to cause meningitis. Theoretical coverage of the 30-valent vaccine candidate would be 77.8% (49/63 isolates) among children with GAS meningitis.

Group A Streptococcal meningitis in adults

We report on the incidence, clinical characteristics, and bacterial genotype of group A streptococcal (GAS) meningitis in the Netherlands. We assessed the incidence, clinical characteristics, and outcome of patients with GAS meningitis from a nationwide cohort study of adults with community-acquired bacterial meningitis in the Netherlands from 2006 to 2013. GAS was identified in 26 of 1322 patients with community-acquired bacterial meningitis (2%); 9 cases (35%) occurred in the first four months of 2013. GAS meningitis was often preceded by otitis or sinusitis (24 of 26 [92%]) and a high proportion of patients developed complications during clinical course (19 of 26 [73%]). Subdural empyema occurred in 8 of 26 patients (35%). Nine patients underwent mastoidectomy and in 5 patients neurosurgical evacuation of the subdural empyema was performed. Five of 26 patients (19%) died and 11 of 21 surviving patient had neurologic sequelae (52%). Infection with the emm1 and cc28 GAS genotype was associated with subdural empyema (both 4 of 6 [67%] vs. 2 of 14 [14%]; P=0.037). GAS meningitis is an uncommon but severe disease. Patients are at risk for empyema, which is associated with infection with the emm1 and cc28 genotype.

Caractéristiques des méningites à streptocoque du groupe A de l’enfant

Group A streptococcal (GAS) meningitis in children are rare. The aim of this study was to analyze the clinical, biological and outcome data on GAS meningitis recorded in the Bacterial Meningitis (BM) French Surveillance Network (GPIP/ACTIV). From 2001 through 2012, 4,564 children suffering from proven bacterial meningitis were recorded in the data base. Among them, 0.7 % were GAS infections. The median age was 5.6 years. A history of community acquired infection before the onset of GAS meningitis was frequent. Apart from the identification of the bacterial species, GAS meningitis were clinically and biologically indistinguishable from meningitis caused by other pathogens notably S. pneumoniae. Case fatality rate was 8 %.

Group A Streptococcus Meningitis in Children

To characterize the epidemiologic burden and the molecular determinants of group A streptococcal (GAS) meningitis among the pediatric population of the state of Paraná, Brazil. Clinical and epidemiologic data were gathered by a compulsory notification system during the period 2003 to 2011. Bacterial identification, antibiotic resistance profile, emm-typing, pulsed-field gel electrophoresis typing and virulence profile were analyzed by a central reference laboratory. A review of published pediatric cases of GAS meningitis from the last 45 years was undertaken and compared with the Brazilian series. The incidence of GAS meningitis among the pediatric population was 0.06 cases per 100,000 children per year and was associated with a case fatality rate of 43%. Neonatal age and the presence of an associated toxic shock syndrome were identified as risk factors for death. A distant focus of infection was present in more than half of the patients in the literature and in 36% in the Brazilian case series. A high diversity of emm-types was associated with GAS meningitis in Brazil. No single virulence determinant could be associated with death. GAS meningitis is associated with high mortality and with a high diversity of GAS emm-types and virulence determinants in Brazil.

Meningites à streptocoque du groupe A

An increased incidence and severity of invasive group A streptococcus (GAS) infections over the past decade have been reported by several authors, but GAS remains an uncommon cause of bacterial meningitis. The aim of this study was to describe and analyze the clinical and biological data of GAS meningitis by reporting 10 new cases of pediatric GAS meningitis and making a literature review. The mean age of patients, seven girls and three boys, was 3 years. There was a history of preexisting or concomitant community-acquired infection in five patients over 10. The outcome was fatal in two cases. All patients received an initial empirical antimicrobial therapy with a third generation cephalosporin switched in six cases to amoxicillin. The prognosis for this type of streptococcal meningitis is usually good, but death may occur even in children without any identified risk factor for severe infection.

Méningite à streptocoque A : caractéristiques d’une méningite rare chez l'enfant

Group A streptococcal (GAS) invasive infections have been increasingly reported in recent years but meningitis due to GAS remains a rare affection. In children some scarce case reports have been described. The aim of this study was to describe and analyze the clinical and biological data on GAS meningitis recorded in the Bacterial Meningitis (BM) French Surveillance Network (GPIP/ACTIV). From 2001 through end 2006, 2539 children suffering from proven bacterial meningitis were recorded in the data base. Among them 10 children presented GAS infections. The mean age was 6 years (9 months to 14.1 years) and the sex ratio (male/female) 4/1. Seven out of the 10 patients had a history of community acquired infection before the onset of GAS meningitis : 3 had previous acute otitis media, 1 otitis media with mastoiditis, 2 sinusitis and 1 soft tissue infection. In the 3 remaining children no risk factors of invasive GAS infection could be identified. All but 1 patient survived. The patient who died had no risk factors for invasive infectious disease. He presented with fulminant septicaemia and died 6hours after hospital admission despite appropriate supportive care and prompt antibiotic treatment. The cerebrospinal fluid examination revealed high white blood cells counts (>500/mm(3)) in 8 patients and Gram stained smear showed gram-positive cocci in 6 patients. All the patients received antibiotic regimen including 3(rd) generation cephalosporins before definite bacterial identification and all the strains were susceptible to the first line antibiotic treatment chosen. GAS is an uncommon organism causing meningitis in children. In our study upper respiratory tract infection is the most common predisposing factor for GAS meningitis but even apparently healthy children can suffer from this severe form of bacterial meningitis.

Burden of group A streptococcal meningitis in Salvador, Brazil: report of 11 years of population-based surveillance

Over recent decades, a resurgence of invasive group A streptococcal (GAS) infections has been observed; GAS remains a rare cause of pyogenic meningitis. We report herein population-based findings of long-term surveillance for GAS meningitis in Salvador, Brazil, and estimate the overall burden of invasive GAS infections. From February 1996 to February 2007 we conducted active surveillance for GAS meningitis in the state reference hospital for infectious diseases in Salvador, Brazil. Data on clinical presentation, laboratory records, and outcome were collected through interviews and chart review. GAS isolates were evaluated for antimicrobial susceptibility and emm type. We identified 20 cases of GAS meningitis, which accounted for 0.9% of all culture-proven bacterial meningitis in the study period. The mean annual incidence of GAS meningitis was 0.03 cases per 100,000 population in metropolitan Salvador and peaked in children <1 year of age (0.67 cases per 100,000 population). Among 17 cases with clinical information available, 41% required intensive care unit support and 25% died. Tested isolates were susceptible to penicillin and exhibited large emm type diversity. Based on the incidence of GAS meningitis, we estimate that the annual incidence of GAS infection is 3 cases per 100,000 population in metropolitan Salvador. Although rare, GAS is a life-threatening cause of bacterial meningitis. Knowledge of the incidence and emm type variability of the disease is necessary for planning immunization strategies.

Fatal group a streptococcal meningitis in an adult

Despite the recent resurgence in reports of invasive Group A Streptococcal (GAS) infections worldwide, it remains a rare cause of pyogenic meningitis both in children and adults. We report a case of fatal GAS meningitis in a healthy adult emphasizing the need for clinicians to be aware of its fulminant course, prompting early diagnosis and treatment. There is also a need to consider postexposure chemoprophylaxis in close contacts of such cases.

Group A Streptococcal Meningitis in a Pediatric Patient following Cochlear Implantation: Report of the First Case and Review of the Literature

The Food and Drug Administration published a public health warning on the association of bacterial meningitis and cochlear implants in June 2002. This article reports the first case of group A streptococcal (GAS) meningitis in a cochlear-implanted patient, followed by a review on cochlear implantation and GAS meningitis.

Group A streptococcal meningitis: Report of two cases

Group A streptococcus (GAS) is a very uncommon cause of bacterial meningitis, with less than 30 cases reported in the last quarter of a century. A recent worldwide increase in the incidence and severity of disease due to Streptococcus pyogenes has been observed. Although a rise of incidence of cases of GAS meningitis has not been shown, severe and fulminant cases have been reported in the literature in the last few years. We performed a retrospective analysis of the computer data of cerebrospinal fluid cultures from July 1987 to December 1995 at the Hadassah University Medical Center in Jerusalem, and report two cases of GAS meninigitis: one with a primary infection acquired through bacteraemia, in a 2-month-old child, and another with meninigitis secondary to cranial surgery in a 75-year-old patient. The cases are discussed and a literature review is presented.