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Meningoencephalitis with Streptococcus equi Subspecies equi Leading to a Dural Arteriovenous Fistula

Jeroen Kerstens1,2, Busra Durmus1, Stijn Lambrecht3

  • 1Antwerp University Hospital, University of Antwerp, Department of Neurology, Edegem 2650, Belgium.

Case Reports in Neurological Medicine
|July 26, 2021
PubMed

Insights

A rare human infection with Streptococcus equi subsp. equi, a horse pathogen, caused severe brain inflammation and lesions. The patient later developed a dural arteriovenous fistula, a rare complication following CNS infection.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Microbiology

Background:

  • Invasive Lancefield group C streptococcal infections in humans are rare, typically caused by Streptococcus dysgalactiae subsp. equisimilis.
  • Streptococcus equi subsp. equi is a horse pathogen rarely implicated in human central nervous system (CNS) infections.

Observation:

  • A 69-year-old man developed meningoencephalitis due to Streptococcus equi subsp. equi.
  • Acute phase showed white matter lesions, indicating bacterial invasiveness and exotoxin release.
  • The patient later presented with multiple cerebral hemorrhages and a suspected dural arteriovenous fistula (DAVF).

Findings:

  • This case represents only the fourth reported human CNS infection with Streptococcus equi subsp. equi.
  • The patient experienced a rare complication of a de novo superficial DAVF following CNS infection.
  • Bacterial invasiveness was evidenced by acute white matter lesions and the subsequent development of a DAVF.

Implications:

  • Highlights the potential for zoonotic transmission of virulent streptococci to humans.
  • Suggests a possible link between CNS infections by invasive bacteria and the development of vascular abnormalities like DAVF.
  • Underscores the need for vigilance regarding rare but severe complications following infections with unusual pathogens.

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