Group B Streptococcus Meningitis Associated with Acute Otitis Media in an Adult Patient

Abstract

Patient: Female, 55-year-old Final Diagnosis: Streptococcus agalactiae meningitis Symptoms: Altered mental status • seizures Medication: — Clinical Procedure: — Specialty: Infectious Diseases Objective: Unusual clinical course Background: We present a case of Group B Streptococcus ( Streptococcus agalactiae or GBS) meningitis in a non-pregnant woman that likely originated from acute otitis media. Although invasive Group B Streptococcal infections are increasing in the United States, GBS meningitis is still rare in non-pregnant adults. At the end, we discuss risk factors for this disease and data that suggest that invasive GBS infection is increasing in the adult and elderly populations of the United States. Case Report: Our patient was a 55-year-old woman with a history of juvenile rheumatoid arthritis who presented with altered mental status after failure of outpatient treatment of otitis media with oral doxycycline and steroids. Upon admission, she was initially afebrile and hemodynamically stable, but she had a rapid decline and required emergent intubation. Blood cultures grew GBS. CSF PCR analysis performed by BioFire ® FilmArray® Meningitis/Encephalitis Panel revealed GBS. Middle-ear fluid and CSF cultures drawn after 1 day of antibiotic therapy did not grow any organisms. Treatment was achieved with high-dose intravenous ceftriaxone for 14 days, and tympanoplasty. At the end of 14 days of antibiotic therapy, the patient had full neurological recovery, without any residual neurological deficits. Conclusions: GBS meningitis is classically associated with neonatal disease, but invasive GBS infection is fairly common in adults and appears to be increasing in incidence secondary to increasing populations living with diabetes, immunosuppressed conditions, and advanced age. Central nervous system infection with this organism is still rare. In this case report we describe a non-pregnant woman who presented with GBS meningitis.

Mania: An atypical presentation of probable Streptococcus agalactiae meningoencephalitis

“…GBS is a Gram-positive, encapsulated pathogen that causes beta hemolysis on blood agar. It is a catalase negative streptococcus, and facultative anaerobe that colonizes human skin, respiratory, gastrointestinal, and urogenital tract [16] , [17] . The exact incidence of invasive GBS in adults is not clear, but an increase in the last decade has been documented.…”

“…CSF is sterile and isolation of GBS from it should not be considered colonization. Adults previously treated with antibiotics as short as one day duration may have negative GBS culture from CSF [21] . Prolonged GBS CSF PCR positivity has been demonstrated to be related to persistent infection in a neonate with ventriculitis and residual brain abscess [22] suggesting that test positivity can be associated with residual infection.…”