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Group B streptococcal meningitis in adults: recent increase in Southeast Asia
E Wilder-Smith1, K M Chow, R Kay
1Department of Neurology, Singapore General Hospital, Singapore. EinarWS@nuh.com.sg
Background:
Meningitis caused by Streptococcus agalactiae (Group B Streptococcus) is rare in adults and usually affects patients with predisposing conditions.
Aims:
To describe an increase in adult group B streptococcal meningitis occurring in parallel in Hong Kong and Singapore.
Methods:
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.
Results:
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.
Conclusions:
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.
Insights
Adult meningitis caused by Streptococcus agalactiae (Group B Streptococcus) has increased in Hong Kong and Singapore. This rise in bacterial meningitis cases occurred without clear predisposing conditions in most adult patients.
Area of Science:
- Infectious Diseases
- Neurology
- Epidemiology
Background:
- Meningitis caused by Streptococcus agalactiae (Group B Streptococcus) is uncommon in adults.
- Typically, adult cases are associated with specific predisposing conditions.
Purpose of the Study:
- To document a concurrent rise in adult group B streptococcal meningitis in Hong Kong and Singapore.
- To investigate the clinical characteristics and risk factors associated with this increase.
Main Methods:
- Retrospective review of adult bacterial meningitis cases (≥15 years) admitted in 1998 to two major hospitals.
- Ten-year historical data search for adult group B streptococcal meningitis cases.
Main Results:
- In 1998, Streptococcus agalactiae was the most common pathogen identified in adult bacterial meningitis (11/29 cases).
- Only two of the 11 adult group B streptococcal meningitis patients had identifiable predisposing conditions.
- A historical review identified only one prior adult case of group B streptococcal meningitis with multiple risk factors.
Conclusions:
- A significant increase in adult group B streptococcal meningitis was observed in Hong Kong and Singapore.
- Predisposing conditions were absent in the majority of these adult cases.
- The underlying reasons for this epidemiological shift in group B streptococcal meningitis remain undetermined.