Group A Streptococcal Meningitis in the Antibiotic Era

Baraldès, Maria A.; Domingo, Peré; Mauri, Albert; Monmany, J.; Pericàs, Juan M.; Vázquez, Guillermo

doi:10.1007/s100960050349

Cited by 24 publications

(24 citation statements)

References 41 publications

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“…pyogenes (group A streptococcus) accounts for 0.2 to 1.2% of all cases of bacterial meningitis in adults and children and is community acquired in the majority of cases (276,318,319). Predisposing conditions are present for 78 to 96% of patients and consist of otitis, sinusitis, pneumonia, recent head injury, recent neurosurgery, the presence of a neurosurgical device, altered immune status, alcoholism, or CSF leakage (20,318). For children, the most common predisposing factor is otitis (251).…”

Section: Streptococcus Pyogenesmentioning

confidence: 99%

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Epidemiology, Diagnosis, and Antimicrobial Treatment of Acute Bacterial Meningitis

2010

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SUMMARY The epidemiology of bacterial meningitis has changed as a result of the widespread use of conjugate vaccines and preventive antimicrobial treatment of pregnant women. Given the significant morbidity and mortality associated with bacterial meningitis, accurate information is necessary regarding the important etiological agents and populations at risk to ascertain public health measures and ensure appropriate management. In this review, we describe the changing epidemiology of bacterial meningitis in the United States and throughout the world by reviewing the global changes in etiological agents followed by specific microorganism data on the impact of the development and widespread use of conjugate vaccines. We provide recommendations for empirical antimicrobial and adjunctive treatments for clinical subgroups and review available laboratory methods in making the etiological diagnosis of bacterial meningitis. Finally, we summarize risk factors, clinical features, and microbiological diagnostics for the specific bacteria causing this disease.

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Section: Streptococcus Pyogenesmentioning

confidence: 99%

“…The reported mortality rates in case series and reviews of the literature vary from 4 to 27% (14,20,251,318). Neurological sequelae have been reported for 28% of children and consisted of learning difficulties, visual-field defects, and hearing defects (251).…”

Section: Streptococcus Pyogenesmentioning

confidence: 99%

Epidemiology, Diagnosis, and Antimicrobial Treatment of Acute Bacterial Meningitis

2010

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“…Among children, GAS infections of the central nervous system (CNS) and peripheral nervous system after chickenpox are extremely rare. [2][3][4] We describe an infant who developed a GAS subdural empyema during varicella, which is, to our knowledge, an association not described previously. …”

mentioning

confidence: 58%

“…The presumed diagnosis of AOM could not be proven for this infant, and he had experienced no previous head trauma, scalp injuries, CSF leaks, or neurosurgical procedures, all of which are considered risk factors for GAS meningitis. 2,3 In addition, he had undergone no previous treatment with nonsteroidal antiinflammatory drugs. Although VZV-associated transient alterations in immune function might have occurred, this possibility was not demonstrated.…”

Section: Discussionmentioning

confidence: 99%

Group A Streptococcal Subdural Empyema as a Complication of Varicella

2005

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ABSTRACT. Group A ␤-hemolytic streptococcus and Staphylococcus aureus are the 2 most common pathogens implicated in secondary invasive bacterial disease after varicella. We describe a 3-month-old male infant from British Columbia, Canada, who presented on day 5 of varicella skin rash with fever, seizures, lethargy, and evidence of intracranial hypertension. A prominent subdural empyema was documented, and Streptococcus pyogenes was recovered from the subdural fluid. Central nervous system bacterial complications should be part of the differential diagnosis for infants and children with chickenpox who present with fever, lethargy, focal seizures, or similar neurologic findings. This case illustrates the importance of universal varicella vaccination to prevent associated bacterial complications of chickenpox. T he clinical course of varicella in childhood is usually benign and self-limited. However, secondary bacterial complications can occur in skin, soft tissues, and other sites, caused predominantly by group A streptococcus (GAS) and Staphylococcus aureus. 1 For varicella-associated, invasive, suppurative complications, the former is associated with increased morbidity and mortality rates among both immunocompetent and immunosuppressed children, and episodes can occur even without an obvious skin source of infection. Among children, GAS infections of the central nervous system (CNS) and peripheral nervous system after chickenpox are extremely rare. [2][3][4] We describe an infant who developed a GAS subdural empyema during varicella, which is, to our knowledge, an association not described previously. CASE REPORTA 3-month-old boy was admitted to a community hospital, on day 5 of a varicella skin rash, with fever and focal seizures. On day 1 of the rash, the patient developed decreased appetite and vomited twice; the following day, he began to exhibit a fever of 39°C. On day 4, he was examined at a primary care clinic, a diagnosis of acute otitis media (AOM) was made, and treatment with orally administered trimethoprim-sulfamethoxazole was initiated (the patient received a total of 2 doses). On day 5, the patient was described by his parents as being irritable and lethargic, and that night he developed right-sided focal seizures of the face, arm and leg, with subsequent ocular deviation. The seizures persisted, became generalized, and led to status epilepticus, which necessitated repeat doses of intravenously administered diazepam and phenytoin after admission to the local hospital. The body temperature was 37.8°C, a diffuse varicella skin rash with no evidence of secondary bacterial infection was described, and no AOM was observed. The patient underwent head computed tomography, which showed bilateral subdural fluid collections with left-sided predominance, with a compressed ventricular system and mild midline deviation. A clinical diagnosis of varicella encephalitis and subdural effusions was made, blood cultures were obtained, 1 dose of acyclovir was administered intravenously, and the patient was transferred...

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“…Meningitis caused by GAS is rare, with fewer than 60 cases reported throughout the literature [1,2,3,6]. Baraldes et al [1] reviewed 51 cases reported in the literature.…”

Section: Discussionmentioning

confidence: 97%