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Published on: July 1, 2018
[A rare case of Streptococcus agalactiae meningitis in previously healthy adult]
Daisuke Kuzume1, Yuko Morimoto1, Masato Kinboshi1
1Department of Neurology, Chikamori Hospital.
Abstract:
A 39-year-old previously healthy man was referred to our hospital because of acute onset of fever and consciousness disturbance. Neurological examinations revealed deteriorated consciousness, nuchal rigidity and Kernig's sign. A lumbar puncture yielded clouded fluid with a WBC 1,012/μl (polynuclear cell 96%), 147.3 mg/dl of protein, 44 mg/dl of glucose and Gram positive cocci. At first, he was treated with ceftriaxon and ampicillin. At Day 2, meropenem was added. Streptococcus agalactiae was isolated from blood and cerebrospinal fluid. He responded promptly to antimicrobial therapy, and within 2 days, he became lucid and afebrile. S. agalactiae was sensitive to ceftriaxone, ampicillin and meropenem. After Day 3, he was treated with meropenem only. We diagnosed his condition as S. agalactiae meningitis and was discharged from our hospital at Day 18. Many cases of S. agalactiae meningitis are known to occur in neonates, pregnant women, elderly, and persons with underlying disease such as diabetes, malignant disorders, liver dysfunction. But cases occurring in a previously healthy adult are rare. Neurologists should be aware that S. agalactiae may be cause bacterial meningitis in a previously healthy adults.
Insights
A previously healthy adult developed Streptococcus agalactiae meningitis, a rare occurrence. Prompt antibiotic treatment led to a full recovery, highlighting the need for awareness in adult bacterial meningitis cases.
Area of Science:
- Neurology
- Infectious Diseases
- Microbiology
Background:
- Streptococcus agalactiae (Group B Streptococcus) meningitis is typically seen in neonates, the elderly, or immunocompromised individuals.
- Cases in previously healthy adults are uncommon, making diagnosis and treatment potentially challenging.
Observation:
- A 39-year-old previously healthy man presented with acute fever and altered consciousness.
- Cerebrospinal fluid analysis revealed bacterial meningitis with Gram-positive cocci, later identified as Streptococcus agalactiae.
Findings:
- The patient received prompt treatment with ceftriaxone, ampicillin, and meropenem.
- S. agalactiae was susceptible to all administered antibiotics, and the patient showed rapid clinical improvement.
- Diagnosis was confirmed as Streptococcus agalactiae meningitis, with complete recovery upon discharge.
Implications:
- This case underscores that Streptococcus agalactiae can cause bacterial meningitis in immunocompetent adults.
- Neurologists and infectious disease specialists should consider S. agalactiae in the differential diagnosis of bacterial meningitis in this demographic.
- Early recognition and appropriate antimicrobial therapy are crucial for favorable outcomes in adult S. agalactiae meningitis.
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