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Streptococcal meningitis in adult patients: current epidemiology and clinical spectrum
C Cabellos1, P F Viladrich, J Corredoira
1Infectious Diseases Service, Ciutat Sanitària i Universitària de Bellvitge, University of Barcelona, Spain. ccabellos@csub.scs.es
Abstract:
Streptococci other than Streptococcus pneumoniae are a rare cause of bacterial meningitis in adults. We report 29 cases of streptococcal meningitis (1977-1997). The patients comprised 19 men and 10 women, with a mean age +/- standard deviation of 47 +/- 18 years. Nine cases were secondary to neurosurgical procedures, seven to brain abscess, five to cerebrospinal fluid pericranial fistula, and three to endocarditis. Causative microorganisms included the following: viridans group streptococci, 20 cases; anaerobic streptococci, 3; Streptococcus agalactiae, 3; Streptococcus bovis, 2; and Streptococcus pyogenes, 1. Four Streptococcus mitis strains showed decreased susceptibility to penicillin (MIC, 0.5-2 microg/mL). Five patients (17%) died. The infection is increasing in the hospital setting. Streptococci resistant to penicillin should be considered in the empirical treatment of nosocomial meningitis. In cases of community-acquired infection, anaerobic streptococci or streptococci of the Streptococcus milleri group should alert the clinician to the presence of an undiagnosed brain abscess, whereas oral streptococci of the viridans group suggest the diagnosis of bacterial endocarditis.
Insights
Non-pneumococcal streptococcal meningitis is rare in adults but increasing in hospitals. Penicillin-resistant strains and specific streptococci types can indicate serious underlying conditions like brain abscess or endocarditis.
Area of Science:
- Infectious Diseases
- Neurology
- Microbiology
Background:
- Streptococcus pneumoniae is the most common cause of bacterial meningitis in adults.
- Non-pneumococcal streptococcal meningitis is infrequently encountered but poses significant diagnostic and therapeutic challenges.
Purpose of the Study:
- To analyze the clinical features, causative agents, and outcomes of non-pneumococcal streptococcal meningitis in adults.
- To identify risk factors and associated conditions for this rare form of meningitis.
- To guide empirical treatment strategies for nosocomial and community-acquired meningitis.
Main Methods:
- Retrospective case series analysis of 29 adult patients diagnosed with streptococcal meningitis between 1977 and 1997.
- Identification of causative streptococcal species and antimicrobial susceptibility testing.
- Review of patient demographics, clinical presentations, predisposing factors, and treatment outcomes.
Main Results:
- The mean age of patients was 47 years, with a slight male predominance.
- Common predisposing factors included neurosurgical procedures (9 cases), brain abscess (7 cases), cerebrospinal fluid pericranial fistula (5 cases), and endocarditis (3 cases).
- Viridans group streptococci were the most frequent isolates (20 cases), followed by anaerobic streptococci (3), Streptococcus agalactiae (3), Streptococcus bovis (2), and Streptococcus pyogenes (1).
- Four Streptococcus mitis strains exhibited reduced penicillin susceptibility (MIC 0.5-2 microg/mL).
- The overall mortality rate was 17% (5 patients).
- A trend towards increasing incidence in the hospital setting was observed.
Conclusions:
- Non-pneumococcal streptococci are an uncommon but serious cause of adult bacterial meningitis.
- Penicillin-resistant streptococci should be considered in empirical treatment regimens for hospital-acquired meningitis.
- Specific streptococcal species can suggest underlying conditions: anaerobic or Streptococcus milleri group point to brain abscess, while viridans group streptococci may indicate bacterial endocarditis.