Streptococcal Meningitis In Adults Research Articles

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

Community-acquired group B streptococcal meningitis in adults: 33 cases from prospective cohort studies

Streptococcus agalactiae (group B streptococcus, GBS) is an uncommon cause of bacterial meningitis in adults. We describe clinical characteristics, serotype distribution and outcome of adult GBS meningitis. Patients aged 16 years or older with GBS cultured in cerebrospinal fluid included in two prospective nationwide cohort studies performed in the Netherlands between 1998-2002 and 2006-2017 were evaluated. We identified 33 patients with GBS meningitis with a median age of 58 years of whom 22 were male (67%). The mean annual incidence was .16 per 1.000.000 adults. Ten patients (30%) had an immunocompromised state, which was due to alcoholism in 6 (18%) and diabetes mellitus in 4 (12%). Eleven patients (33%) had a distant focus of infection of whom 4 had endocarditis (13%). Seven patients (21%) died and 6 (18%) survivors had sequelae causing disability, including reduced vision and blindness due to endophthalmitis (n = 2). Twenty patients (61%) made a full recovery. Most common bacterial serotypes were serotype III (41%) and Ia (25%). Serotype V was associated with increased mortality (3 of 4 [75%] serotype V died vs. 4 of 28 [14%] other serotypes, P = .025). GBS is a rare cause of meningitis in adults that more frequently occurs in patients with underlying comorbidities. Patients should be carefully evaluated for distant foci of infection. GBS serotype V is associated with poor outcome.

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.

Clinical microbiological case: a firm, right infraclavicular mass in an adult woman with connective tissue disease

Clinical microbiological case: a firm, right infraclavicular mass in an adult woman with connective tissue disease

Identification of viridans streptococcal species causing bacterial meningitis in adults in Taiwan.

In order to determine the species responsible for viridans-group streptococcal meningitis in adults in Taiwan, seven cases of culture-proven meningitis due to these organisms were studied. The cases were all identified at the Chang Gung Memorial Hospital-Kaohsiung over a period of 3 years, and they accounted for 9% (7/78) of all cases of culture-proven bacterial meningitis occurring in adults during this period. Of the seven viridans streptococci isolates recovered, Streptococcus constellatus accounted for four, Streptococcus anginosus for two, and Streptococcus oralis for one. Thus, it appears that streptococci of the milleri group are the most common species causing bacterial meningitis in adults in Taiwan. The tendency for these organisms to cause invasive central nervous system infections in adults should not be overlooked when these species are recovered from cerebrospinal fluid specimens.

Streptococcal meningitis in adults: therapeutic outcomes and prognostic factors

Thirty-eight patients with streptococcal meningitis, aged 17–75 years, have been identified over a period of 13.5 years. Among these 38 patients, 35 had community-acquired infections, and the other three had nosocomial infections. Twelve of the 38 patients were found to have postneurosurgical forms and 26 to have spontaneous forms. These 38 cases of streptococci included Streptococcus (S.) pneumoniae in 19 cases, viridans group streptococci in 13, non-A, non-B, and non-D streptococci in three, Group D streptococci in one, and Group B streptococci ( S. agalactiae) in two. Although one case was found to have penicillin-resistant S. pneumoniae PRSP in 1994, multi-antibiotic resistant strains were rare in this study. Therapeutic outcomes varied according to the different species of streptococci. In this study, the overall mortality rate was 34%. In the multiple logistic regression analysis, only initial consciousness level and the presence of seizure were strongly associated with the mortality rate even after other potentially confounding factors were adjusted for. Early diagnosis and the use of appropriate antibiotics are essential for survival.

Group B streptococcal meningitis in adults: recent increase in Southeast Asia.

Meningitis caused by Streptococcus agalactiae (Group B Streptococcus) is rare in adults and usually affects patients with predisposing conditions. To describe an increase in adult group B streptococcal meningitis occurring in parallel in Hong Kong and Singapore. All cases of bacterial meningitis admitted to the Prince of Wales Hospital, Hong Kong and Singapore General Hospital in 1998, aged 15 years or above, were reviewed. Medical records for the previous ten years were searched for previous cases of adult group B streptococcal meningitis. In 1998, 29 adult patients with bacterial meningitis were admitted to the two hospitals. S. agalactiae was isolated in 11 cases, Streptococcus pneumoniae in three cases, Klebsiella pneumoniae in two cases, and Pseudomonas pseudomallei in one case. In 11 cases no bacteriological diagnosis could be made. Two patients with adult group B streptococcal meningitis had predisposing conditions for infection. One patient died before a definite diagnosis could be established. A ten year review of records revealed one previous case of adult group B streptococcal meningitis in a patient with multiple risk factors. An increase of group B streptococcal meningitis has occurred among adults admitted to two major hospitals in two Southeast Asian cities. In the majority of cases there were no identifiable predisposing conditions. The cause of this increase of group B streptococcal remains unclear.

Group B streptococcal meningitis in adults: report of twelve cases and review.

Group B streptococcus (GBS) is the leading etiologic agent of bacterial meningitis and sepsis during the neonatal period, but it is an infrequent cause of meningitis in adults. We report 12 episodes of group B streptococcal meningitis in adults and review 52 cases reported in the literature. A total of 24 men and 40 women were included in the study; the mean age (+/- SD) was 49.2 +/- 20.5 years (range, 17-89 years). All the patients had cerebrospinal fluid cultures positive for GBS. Eighty-six percent of the patients had comorbid conditions, 50% had a distant focus of infection, and blood cultures yielded GBS for 78.7%. The overall case-fatality rate was 34.4% (22 patients). Factors associated with a poor outcome were advanced mean age (+/- SD) (61.5 +/- 17.4 years vs. 42.8 +/- 19.2 years; P = .0003) and the presence of complications on admission (P = .0001). Seven percent of survivors had neurological sequelae. Group B streptococcal meningitis in adults has become increasingly frequent in recent years; it tends to occur in patients with severe underlying conditions and is associated with a high case-fatality rate. Factors associated with a poor prognosis are advanced age and the occurrence of neurological and extraneurological complications.

Group B Streptococcal Meningitis in Adults: Case Report and Review of the Literature

A case of group B streptococcal meningitis in an adult is presented with a review of 42 other cases reported in the English literature since 1940. Their median age was 58 years (72.5% were older than 45 years). Male/female ratio was 0.9:1, with male predominance in patients older than 60 years (76.5%). Predisposing illnesses were common but 13.9% of cases reported had no identifiable risk factor. Encephalopathy and bacteremia were frequent (81.3% and 94.4% respectively) and many patients (30%) had other foci of infection. Gram stain of cerebrospinal fluid was positive in 75% of cases. Mortality was 18.4% and 9.7% of survivors had bilateral hearing loss. Thus, this review illustrates that group B streptococcal meningitis in adults is a rare disease which occurs among high risk individuals. It is characterized by frequent encephalopathy, prevalence of other foci of infection and bacteremia with an outcome similar to other types of purulent meningitides.

Group B Streptococcal Meningitis in Adults: Case Report and Review of the Literature

A case of group B streptococcal meningitis in an adult is presented with a review of 42 other cases reported in the English literature since 1940. Their median age was 58 years (72.5% were older than 45 years). Male/female ratio was 0.9:1, with male predominance in patients older than 60 years (76.5%). Predisposing illnesses were common but 13.9% of cases reported had no identifiable risk factor. Encephalopathy and bacteremia were frequent (81.3% and 94.4% respectively) and many patients (30%) had other foci of infection. Gram stain of cerebrospinal fluid was positive in 75% of cases. Mortality was 18.4% and 9.7% of survivors had bilateral hearing loss. Thus, this review illustrates that group B streptococcal meningitis in adults is a rare disease which occurs among high risk individuals. It is characterized by frequent encephalopathy, prevalence of other foci of infection and bacteremia with an outcome similar to other types of purulent meningitides.

Group C Streptococcal Meningitis in Adults

Group C Streptococcal Meningitis in Adults Get access O. Patey, O. Patey Department of Infectious and Tropical Diseases Villeneuve St. George's Hospital and the Intensive Care Unit and Laboratory of Microbiology Henri Mondor HospitalCréteil, France Search for other works by this author on: Oxford Academic PubMed Google Scholar C. Brun Buisson, C. Brun Buisson Department of Infectious and Tropical Diseases Villeneuve St. George's Hospital and the Intensive Care Unit and Laboratory of Microbiology Henri Mondor HospitalCréteil, France Search for other works by this author on: Oxford Academic PubMed Google Scholar C. J. Soussy C. J. Soussy Department of Infectious and Tropical Diseases Villeneuve St. George's Hospital and the Intensive Care Unit and Laboratory of Microbiology Henri Mondor HospitalCréteil, France Search for other works by this author on: Oxford Academic PubMed Google Scholar Reviews of Infectious Diseases, Volume 12, Issue 1, January 1990, Pages 157–158, https://doi.org/10.1093/clinids/12.1.157 Published: 01 January 1990

Meningitis caused by Streptococcus in adults.

Meningitis caused by Streptococcus is uncommon in adults. Otitis media, mastoiditis, sinusitis, or trauma has antedated most cases reported in the past. Data on 10 recent cases suggest changes in the current pathogenesis of streptococcal meningitis in adults and emphasize the importance of accurate streptococcal speciation. Endocarditis was present in five cases; trauma played a role in two others. Brain abscess, corticosteroids, alcoholic cirrhosis, and peritonitis secondary to chronic peritoneal dialysis were etiologic factors in five patients. Otitis media, mastoiditis, and sinusitis were conspicuously absent. Streptococcus agalctiae accounted for purulent meningitis in two postmenopausal women. Both strains of group B Streptococcus were bacitracin-sensitive and were thus mislabeled group A. Recognition of Streptococcus bovis spared two patients unnecessary aminoglycoside adminstration. Nine of the 10 patients survived, including a women with prosthetic mitral valve endocarditis and a man with a ruptured brain abscess. Differentiation of these streptococci from Streptococcus pneumoniae was seldon possible on the basis of the spinal fluid gram stain alone.

STREPTOCOCCAL MENINGITIS

STREPTOCOCCAL MENINGITIS