Méningo-encéphalite à Streptococcus agalactiae chez l’adulte non immunodéprimé

Abstract

Streptococcus agalactiae est un Streptocoque beta-hémolytique du groupe B (SGB), c'est un germe commensal occasionnel de la peau, du tube digestif et des voies génito-urinaires. Nous rapportons un cas inhabituel d'une méningo-encéphalite due au Streptococcus agalactiae (SGB) multisensible à l'antibiogramme chez un sujet adulte immunocompétent admis au service des urgences pour prise en charge de troubles de conscience fébrile. L’évolution clinique et biologique à J10 était favorable et le patient à été transféré au service de neurologie pour complément de prise en charge secondaire. L'originalité de notre observation réside dans la rareté du type d'infection par ce germe puise qu'elle est la troisième à notre connaissance d'une méningo-encéphalite à Streptococcus agalactiae dans la littérature, c'est ainsi que même s'il est très rarement en cause, il doit être considéré comme une étiologie possible de méningo-encéphalite chez l'adulte en dehors de la grossesse, quelle que soit le statut immunitaire du patient, et sans méconnaitre le rôle du terrain sous-jacent dans l’émergence de cette pathologie infectieuse polymorphe est potentiellement grave.

Negative HIV encephalitis and meningoencephalitis management algorithm Decision-making

“…Encephalitis is an inflammatory condition of the brain tissue responsible for neurological dysfunction, sometimes of infectious origin or not, they can evolve in an acute, subacute or chronic mode (1,2). They are relatively frequent (incidence in the world: 3.5 to 7.4 per 100,000 inhabitants per year) (1), resulting in high mortality (10 to 12%) or sometimes heavy sequelae for the survivors (25.5-46.5 %) (3)(4)(5)(6).…”

“…It is sometimes associated with meningeal involvement (meningoencephalitis) (8) or spinal cord involvement (encephalomyelitis) (9). In these infectious attacks, it is necessary to differentiate the acute attacks comprising cerebral lesions caused by the invasion and the replication or the multiplication of the infectious agent within the cerebral parenchyma from the so-called post-infectious attacks for which the infectious agent is absent in the central nervous system (CNS) (6). During primary acute encephalitis, different anatomical sites can be affected and the topography of the sometimes-necrotic lesions observed points towards an etiological diagnosis.…”

“…During primary acute encephalitis, different anatomical sites can be affected and the topography of the sometimes-necrotic lesions observed points towards an etiological diagnosis. For these attacks, the penetration of the infectious agent into the CNS is done either by crossing the blood-brain barrier, or via retrograde neuronal transport (6). Post-infectious encephalitis reflects an "aberrant" immunological reaction developed against white matter antigens during an infectious syndrome.…”

“…There is no infectious agent or necrotic lesions in the CNS (8). Despite a better understanding of the pathophysiological mechanisms and technological advances that make it possible to considerably improve the diagnosis of infectious encephalitis, in particular thanks to PCR (10), revealing the major role of HSV, Mycobacterium tuberculosis and listeria monocytogenes, particularly in developing countries, the etiological diagnosis of encephalitis remains difficult and the etiology of infectious encephalitis is undetermined in nearly half of the cases (5,6). However, it has been shown that an accurate diagnosis allows better therapeutic management and a reduction in mortality and morbidity associated with infectious encephalitis.…”