A 56-Year-Old Woman with Chronic Hepatitis C Liver Disease and Meningitis due to Streptococcus equi subsp. Zooepidemicus

Abstract

Streptococcus equi subsp. zooepidemicus (S. equi subsp. zooepidemicus), which carries the Lancefield group C antigen, is an uncommon human pathogen. It is considered an opportunistic commensal of the equine upper respiratory tract and causes invasive infections in immunocompromised hosts, following close contact to infected horses. Meningitis caused by S. equi subsp. zooepidemicus is a rare infectious disease with high rates of complications. We present the case of a 56-year-old female with acutely altered mental status following three days of fever and vomiting. For several months, she was taking care of horses. The most relevant preexisting illnesses were chronic hepatitis C infection and traumatic paraplegia due to spinal cord injury 30 years ago. Laboratory evaluation on admission revealed leukocytosis, hyponatremia, and elevated C-reactive protein. Cerebral CT scan showed diffuse cerebral edema. Whereas cerebrospinal fluid real-time PCR assay for common pathogens was negative, cultures showed S. equi subsp. zooepidemicus. She recovered fully after intravenous administration of ceftriaxone for four weeks. This is one of only few reported cases of S. equi subsp. zooepidemicus meningitis and the first case in chronic hepatitis C infection. Our case supports the necessity for extended microbiological examination especially in immunocompromised patients if PCR examination for common pathogens is negative.

Characterization of Streptococcus equi subsp. zooepidemicus isolates containing lnuB gene responsible for the L phenotype

“…These findings correlate with previous observations pointing out SEZ as an uncommon but serious cause of human infections, particularly in elderly with underlying medical conditions or immunosuppression, and persons exposed to animals or animal products [3][4][5]36,37]. Group C streptococci meningitis is a rare type of infection, with approximately 50 cases reported, where SEZ appears as the most frequent causative agent [38][39][40]. Particularly in Latin-America, only three descriptions of meningitis caused by SEZ have been reported, one of them with a fatal outcome [40][41][42].…”

Polymicrobial Bacterial Meningitis in a Patient with Chronic Suppurative Otitis Media: Case Report and Literature Review

“…In addition, immunosuppression is a risk factor for polybacterial meningitis [ 14 ]. Even if our patient was known to have an untreated chronic HCV infection, which induces a functional impairment of CD4+ as well as CD8+ T cells [ 15 ], this does not fall into the category of immunosuppressed patient [ 13 ].…”

Membrane vesicle delivery of a streptococcal M protein disrupts the blood–brain barrier by inducing autophagic endothelial cell death

“…An outbreak of SEZ ST194 in 2019 in North American pig farms led to the sudden death of thousands of pigs ( 3 , 6 ). Meningitis is a very common clinical manifestation caused by SEZ infection in both humans and pigs ( 7 – 11 ). In experimental infection of pigs with swine-isolated SEZ ST194, 80% of animals had high SEZ burdens in their cerebrospinal fluid (CSF), suggesting that this pathogen is capable of disrupting the blood–brain barrier (BBB) and infecting the central nervous system (CNS) ( 4 ).…”