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

Kassel, Merel N van; Bijlsma, Merijn W.; Brouwer, Matthijs C.; Ende, Arie van der; Beek, Diederik van de

doi:10.1016/j.jinf.2018.07.009

Cited by 23 publications

(29 citation statements)

References 22 publications

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“…Group B streptococcus (GBS), or Streptococcus agalactiae is an encapsulated, Gram positive β-hemolytic facultative bacteria that produce a narrow zone of hemolysis on a sheep blood agar. Although it normally colonizes in the gastrointestinal and genitourinary tract of an asymptomatic hosts, 2 GBS is one of the leading causes of sepsis and meningitis in children younger than 3 years old, especially in the neonates. 1,2 It is, however, an uncommon cause of community-acquired bacterial meningitis in adults where it accounts only in 1.3% of total meningitis cases in adult, 2 and usually occurs in the elderly or in patients with severe underlying comorbidities that increased risk of infections, such as diabetes mellitus, liver cirrhosis, advance kidney disease, chronic alcoholism, or having a distant foci of infections.…”

Section: Discussionmentioning

confidence: 99%

“…Although it normally colonizes in the gastrointestinal and genitourinary tract of an asymptomatic hosts, 2 GBS is one of the leading causes of sepsis and meningitis in children younger than 3 years old, especially in the neonates. 1,2 It is, however, an uncommon cause of community-acquired bacterial meningitis in adults where it accounts only in 1.3% of total meningitis cases in adult, 2 and usually occurs in the elderly or in patients with severe underlying comorbidities that increased risk of infections, such as diabetes mellitus, liver cirrhosis, advance kidney disease, chronic alcoholism, or having a distant foci of infections. 3,4 The clinical manifestation of GBS meningitis is similar with meningitis caused by other pathogens, which is acute onset and associated with neurological dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…1 Factors associated with high mortality include advanced age, the presence of neurological complications such as coma or focal localizing signs, and systemic complications such as respiratory failure, kidney failure, shock, or consumption coagulopathy. [2][3][4] In terms of treatment, the majority of GBS infections are fortunately still sensitive to the penicillin group of antibiotics, as well as cephalosporins and vancomycin as the alternatives. 6 Therefore, a high index of suspicion among clinicians in order to initiate the appropriate treatment timely is the key to successful treatment of GBS meningitis.…”

Section: Discussionmentioning

confidence: 99%

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Group B Streptococcal Meningitis in a Healthy Young Woman: A Case Report

Payus¹,

Clarence²,

Ali³

2020

IJGM

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Group B streptococcus (GBS) is a rare cause of meningitis in adults that commonly affects patients with multiple underlying comorbidities. Although it is uncommon, it typically progresses very rapidly and has a high mortality rate as compared to other causes of bacterial meningitis. Here, we report a patient with GBS meningitis who had no underlying medical illness and presented with multiple episodes of seizure within hours of developing fever. Cerebrospinal fluid analysis results were consistent with bacterial meningitis, and blood cultures grew GBS. She was treated with intravenous ceftriaxone for 2 weeks and made a great recovery without any sequalae. In conclusion, although GBS meningitis is uncommon in adults, it is a serious medical disease and associated with a high mortality rate. To the best of our knowledge, this patient represents one of the few reported cases of GBS meningitis in a previously healthy young adult.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Group B Streptococcal Meningitis in a Healthy Young Woman: A Case Report

Payus¹,

Clarence²,

Ali³

2020

IJGM

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“…The findings from a recent review article describing community-acquired GBS meningitis in 141 adult patients suggest that GBS meningitis in adults most frequently develops between 41 and 66 years of age, and is equally frequent in men and women (52% vs 48%). 20 Autoimmune disease and/or immunosuppressive therapy, in addition to diabetes or hepatic disorders, was indicated as one of the important predisposing factors for adult GBS meningitis. 20 These findings were consistent with those of the present case.…”

Section: Discussionmentioning

confidence: 99%

“… 20 Autoimmune disease and/or immunosuppressive therapy, in addition to diabetes or hepatic disorders, was indicated as one of the important predisposing factors for adult GBS meningitis. 20 These findings were consistent with those of the present case. Forty-four (31%) of the 141 patients died within five days of admission, and deaths were related with advanced age and an immunocompromised condition.…”

Section: Discussionmentioning

confidence: 99%

A Case Report of Cerebral Meningitis Caused by Penicillin-Non-Susceptible Group B Streptococcus in an Immunocompromised Adult Patient

Hirai¹,

Kinjo²,

Haranaga³

et al. 2020

IDR

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Streptococcus agalactiae , also known as Group B Streptococcus (GBS), is the leading cause of bacteremia and meningitis in neonates; however, it also causes meningitis in adults, although much less frequently. After the detection of penicillin-non-susceptible GBS (PRGBS) for the first time in 2008 by Japanese researchers, clinical PRGBS isolates have been reported worldwide. These isolates need to be given due attention for being non-susceptible to multiple drugs. Herein, we present the first clinical report of meningitis caused by PRGBS. A 41-year-old Japanese male receiving an immunosuppressant visited hospital complaining of fever. Although he did not have meningitis-related symptoms or physical findings, determination of the cause of fever by Gram-staining of the spinal fluid revealed gram-positive cocci in pairs and chains. Initially, he was hospitalized on the diagnosis of cerebral meningitis caused by Streptococcus pneumoniae . However, culture of the spinal fluid revealed the β-hemolytic colonies on blood agar. Biochemical testing and mass spectrometry revealed the isolated organism as GBS (serotype Ib). The minimum inhibitory concentration (MIC) of penicillin G for the isolated strain was 0.5 μg/mL, which is greater than the MIC criteria for “susceptibility” to penicillin G for beta-hemolytic streptococci according to Clinical and Laboratory Standards Institute standards. The isolated strain was also resistant to macrolide (MIC ≥ 8 μg/mL) and fluoroquinolone (MIC ≥ 8 μg/mL). The patient recovered without neurologic sequelae upon treatment with ceftriaxone, vancomycin, and corticosteroids for 4 days, and subsequently with ampicillin for 17 days. The rate of isolation of PRGBS in the clinics has gradually increased, particularly in Japan. Although PRGBS isolated in the present case was susceptible to ampicillin and cephalosporins, strains not susceptible to ampicillin, cefotaxime, and ceftriaxone have already been isolated, indicating the prospects for limited range of effective antibiotics against PRGBS infections, including meningitis, in the near future.

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Global Case Fatality of Bacterial Meningitis During an 80-Year Period

van Ettekoven,

Liechti,

Brouwer

et al. 2024

JAMA Netw Open

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ImportanceThe impact of vaccination, antibiotics, and anti-inflammatory treatment on pathogen distribution and outcome of bacterial meningitis over the past century is uncertain.ObjectiveTo describe worldwide pathogen distribution and case fatality ratios of community-acquired bacterial meningitis.Data SourcesGoogle Scholar and MEDLINE were searched in January 2022 using the search terms bacterial meningitis and mortality.Study SelectionIncluded studies reported at least 10 patients with bacterial meningitis and survival status. Studies that selected participants by a specific risk factor, had a mean observation period before 1940, or had more than 10% of patients with health care–associated meningitis, tuberculous meningitis, or missing outcome were excluded.Data Extraction and SynthesisData were extracted by 1 author and verified by a second author. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Random-effects models stratified by age (ie, neonates, children, adults), Human Development Index (ie, low-income or high-income countries), and decade and meta-regression using the study period’s year as an estimator variable were used.Main Outcome and MeasureCase fatality ratios of bacterial meningitis.ResultsThis review included 371 studies performed in 108 countries from January 1, 1935, to December 31, 2019, describing 157 656 episodes. Of the 33 295 episodes for which the patients’ sex was reported, 13 452 (40%) occurred in females. Causative pathogens were reported in 104 598 episodes with Neisseria meningitidis in 26 344 (25%) episodes, Streptococcus pneumoniae in 26 035 (25%) episodes, Haemophilus influenzae in 22 722 (22%), other bacteria in 19 161 (18%) episodes, and unidentified pathogen in 10 336 (10%) episodes. The overall case fatality ratio was 18% (95% CI, 16%-19%), decreasing from 32% (95% CI, 24%-40%) before 1961 to 15% (95% CI, 12%-19%) after 2010. It was highest in meningitis caused by Listeria monocytogenes at 27% (95% CI, 24%-31%) and pneumococci at 24% (95% CI, 22%-26%), compared with meningitis caused by meningococci at 9% (95% CI, 8%-10%) or H influenzae at 11% (95% CI, 10%-13%). Meta-regression showed decreasing case fatality ratios overall and stratified by S pneumoniae, Escherichia coli, or Streptococcus agalactiae (P &lt; .001).Conclusions and RelevanceIn this meta-analysis with meta-regression, declining case fatality ratios of community-acquired bacterial meningitis throughout the last century were observed, but a high burden of disease remained.

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

Cited by 23 publications

References 22 publications

<p>Group B Streptococcal Meningitis in a Healthy Young Woman: A Case Report</p>

<p>Group B Streptococcal Meningitis in a Healthy Young Woman: A Case Report</p>

<p>A Case Report of Cerebral Meningitis Caused by Penicillin-Non-Susceptible Group B <em>Streptococcus</em> in an Immunocompromised Adult Patient</p>

Global Case Fatality of Bacterial Meningitis During an 80-Year Period

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