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

Area of Science:

• Infectious Diseases
• Neurology
• Microbiology

Background:

• Streptococcus agalactiae, or group B Streptococcus (GBS), is an infrequent cause of bacterial meningitis in adult populations.
• Adult GBS meningitis presents unique clinical characteristics, serotype distributions, and patient outcomes that warrant detailed investigation.

Purpose of the Study:

• To describe the clinical features, serotype distribution, and outcomes of adult patients diagnosed with GBS meningitis.
• To identify risk factors and specific GBS serotypes associated with increased mortality in adult meningitis cases.

Main Methods:

• Evaluation of adult patients (≥16 years) with GBS cultured from cerebrospinal fluid.
• Inclusion in two prospective nationwide cohort studies in the Netherlands (1998-2002 and 2006-2017).

Main Results:

• Thirty-three adult GBS meningitis cases were identified, with a median age of 58 years; 67% were male.
• Comorbidities like alcoholism (18%) and diabetes (12%) were common, as were distant infections (33%), including endocarditis (13%).
• Mortality was 21%, with 18% of survivors experiencing sequelae; GBS serotype V was significantly associated with increased mortality (75% vs. 14%).

Conclusions:

• GBS meningitis is a rare but serious condition in adults, often associated with underlying health issues and potential distant infection foci.
• Prompt and thorough evaluation for secondary infection sites is crucial for managing adult GBS meningitis.
• Serotype V GBS strains are linked to a poorer prognosis in adult meningitis patients.