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Group A streptococcal meningitis
1Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pennsylvania.
Abstract:
Meningitis due to group A streptococci occurs uncommonly. We report two cases, one in a patient with otitis media and the other in a patient with bullous pemphigoid. Nineteen cases in the English-language literature from the past decade plus our two cases are reviewed. In 17 patients, an associated illness was present, most often otitis media or pharyngitis. When performed, gram staining of the cerebrospinal fluid and cultures of blood usually yielded organisms. Cerebrospinal fluid was acellular in two patients. Of 21 patients, 20 survived. Antibiotic therapy, which consisted of penicillin for most patients, was effective. Ceftriaxone may be an alternative agent. Neurologic sequelae occurred more often in children than in adults.
Insights
Group A Streptococcus meningitis is rare but treatable. Most patients survive with antibiotics like penicillin, though associated illnesses and neurologic sequelae in children require attention.
Area of Science:
- Infectious Diseases
- Neurology
- Microbiology
Background:
- Group A Streptococcus (GAS) meningitis is an uncommon but serious infection.
- Prompt diagnosis and treatment are crucial for patient outcomes.
Observation:
- Two new cases of GAS meningitis are presented, one associated with otitis media and another with bullous pemphigoid.
- A review of 21 cases (including these two) from the past decade reveals associated illnesses in 17 patients, frequently otitis media or pharyngitis.
Findings:
- Cerebrospinal fluid (CSF) Gram staining and blood cultures were often diagnostic.
- Most patients (20/21) survived with antibiotic therapy, primarily penicillin.
- Ceftriaxone is a potential alternative antibiotic.
- Neurologic sequelae were more common in pediatric patients compared to adults.
Implications:
- Early recognition of GAS meningitis, especially in patients with predisposing conditions, is vital.
- Effective antibiotic regimens, including penicillin or ceftriaxone, lead to favorable outcomes.
- Vigilance for potential neurologic complications, particularly in children, is warranted.