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Meningitis caused by Streptococcus in adults
Abstract:
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.
Insights
Streptococcal meningitis in adults is changing, with fewer cases linked to traditional causes like ear infections. Accurate identification of Streptococcus species is crucial for effective treatment and improved patient outcomes.
Area of Science:
- Infectious Diseases
- Microbiology
- Neurology
Background:
- Meningitis caused by Streptococcus is rare in adults.
- Historically, otitis media, mastoiditis, sinusitis, or trauma preceded most cases.
- Recent data suggest evolving pathogenesis of adult streptococcal meningitis.
Purpose of the Study:
- To analyze recent cases of adult streptococcal meningitis.
- To identify changes in etiological factors and pathogenesis.
- To highlight the importance of precise streptococcal speciation.
Main Methods:
- Retrospective analysis of 10 adult cases of streptococcal meningitis.
- Review of clinical data, including comorbidities and preceding conditions.
- Microbiological identification and speciation of Streptococcus isolates.
Main Results:
- Otitis media, mastoiditis, and sinusitis were notably absent in this series.
- Endocarditis was present in 50% of cases; trauma in 20%.
- Streptococcus agalactiae caused meningitis in two women, initially misidentified due to bacitracin sensitivity.
- Streptococcus bovis identification prevented unnecessary aminoglycoside use.
- Nine out of ten patients survived, including complex cases.
Conclusions:
- Adult streptococcal meningitis pathogenesis appears to be shifting away from common upper respiratory tract infections.
- Accurate identification of Streptococcus species (e.g., S. agalactiae, S. bovis) is critical for appropriate management.
- Distinguishing from Streptococcus pneumoniae based on Gram stain alone is challenging.