Meningitis due to group C Streptococcus: a case report and review of the literature.
Abstract: Group C streptococci (GCS) are common causes of veterinary diseases and may colonize humans. Human diseases due to GCS are uncommon and generally occur in the elderly and persons exposed to animals or animal products. We report a case of Streptococcus equi subsp. zooepidemicus meningitis in a horse trainer and review 36 cases of GCS meningitis reported in the literature. The median age was 48 y and the majority of patients were previously healthy. Thirty-one percent (11/36) of the reported cases followed equine exposure and 19% (7/36) ingestion of dairy products. Sixty-seven percent (24/36) were found to have concomitant bacteraemia. The case fatality rate was 31% (11/36), and 28% (7/25) of survivors were reported to have residual neurological impairments. At least 4 days of antibiotics were typically required before symptoms improved. Isolates were generally susceptible to beta-lactams. In conclusion, it is important to consider GCS in the differential of bacterial meningitis, in particular in elderly patients exposed to horses or dairy products. Beta-lactams are first-line therapy, but outcomes are poor.
Publication Date: 2010-07-17 PubMed ID: 20632899DOI: 10.3109/00365541003754428Google Scholar: Lookup
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Summary
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The research article focuses on the rare occurrence of meningitis caused by group C Streptococcus in humans, particularly those in contact with animals or their products, and reviews 36 similar cases. Outcomes from the treatment of this type of meningitis are generally poor despite the bacteria’s susceptibility to beta-lactam antibiotics.
Background and Case Report
- This research focuses on a type of bacterial meningitis caused by group C Streptococcus (GCS), more specifically the subspecies Streptococcus equi subsp. zooepidemicus.
- It’s underlined that GCS more commonly induces veterinary diseases, but humans can also be colonized. The infections in humans are still quite uncommon.
- The report presents a case of a horse trainer who developed this type of meningitis, the reason being the exposure to horses.
Review of Cases in the Literature
- The study reviews 36 prior reported cases of GCS meningitis.
- The patients’ median age was 48 years, and they were predominantly healthy individuals before the infection.
- More than one-third of these cases sprang from contact with horses (31%), and 19% were due to the consumption of dairy products.
- Of the reported cases, 67% had simultaenous bacteraemia, an infection spread through the bloodstream.
Case Fatality Rate and After Effects
- The research highlights a high fatality rate of 31%, indicating this type of meningitis is quite lethal.
- Even survivors didn’t escape completely unscathed—28% of them ended up with persisting neurological deficiencies.
- Most of the patients showed improvement only after at least 4 days of antibiotic treatment.
Diagnosis and Treatment
- Given the potential sources of exposure—animal contact and dairy products intake—GCS should be considered during the differential diagnosis of bacterial meningitis, especially in elderly patients.
- The first-line therapy for these infections are beta-lactam antibiotics.
- Interestingly, despite the bacteria’s susceptibility to those antibiotics, the general outcomes remained poor.
Cite This Article
APA
Rajasekhar A, Clancy CJ.
(2010).
Meningitis due to group C Streptococcus: a case report and review of the literature.
Scand J Infect Dis, 42(8), 571-578.
https://doi.org/10.3109/00365541003754428 Publication
Researcher Affiliations
- Department of Medicine, University of Florida, Gainesville, Florida, USA.
MeSH Terms
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Animals
- Anti-Bacterial Agents / therapeutic use
- Child
- Child, Preschool
- Female
- Foodborne Diseases / diagnosis
- Foodborne Diseases / epidemiology
- Foodborne Diseases / microbiology
- Horses
- Humans
- Infant
- Infant, Newborn
- Male
- Meningitis, Bacterial / diagnosis
- Meningitis, Bacterial / epidemiology
- Meningitis, Bacterial / microbiology
- Meningitis, Bacterial / mortality
- Middle Aged
- Mortality
- Occupational Exposure
- Streptococcal Infections / diagnosis
- Streptococcal Infections / epidemiology
- Streptococcal Infections / microbiology
- Streptococcal Infections / mortality
- Streptococcus equi / isolation & purification
- Treatment Outcome
- Young Adult
- Zoonoses / microbiology
- Zoonoses / transmission
Citations
This article has been cited 15 times.- Bohlman T, Waddell H, Schumaker B. A case of bacteremia and pneumonia caused by Streptococcus equi subspecies equi infection in a 70-year-old female following horse exposure in rural Wyoming. Ann Clin Microbiol Antimicrob 2023 Aug 2;22(1):65.
- Azpiroz MF, Burger N, Mazza M, Rodríguez G, Camou T, García Gabarrot G. Characterization of Streptococcus equi subsp. zooepidemicus isolates containing lnuB gene responsible for the L phenotype. PLoS One 2023;18(4):e0284869.
- Jara LM, Angulo-Tisoc J, Giménez-Lirola LG, Li G, Andrade R, Mamani J. Outbreak of Pathogenic Streptococcus equi subsp. zooepidemicus in Guinea Pigs Farms of The Andean Region. Pathogens 2023 Mar 12;12(3).
- Klapa S, Grefer J, Sobottka I, Kurowski V. A 56-Year-Old Woman with Chronic Hepatitis C Liver Disease and Meningitis due to Streptococcus equi subsp. Zooepidemicus. Case Rep Crit Care 2021;2021:7227054.
- Sevilla-Acosta F, Ballestero-Pernudi A, Jiménez-Cruz E, Álvarez-Cabalceta H, Naranjo-Zuñiga G. Streptococcus equi subspecies zooepidemicus Meningitis, Septicemia, and Brain Infarcts in a Costa Rican Infant. Cureus 2021 Aug;13(8):e17286.
- Kerstens J, Durmus B, Lambrecht S, Baar I, Ieven MM, Van Der Zijden T, Parizel PM, Menovsky T, Lammens MMY, Jorens PG. Meningoencephalitis with Streptococcus equi Subspecies equi Leading to a Dural Arteriovenous Fistula. Case Rep Neurol Med 2021;2021:9898364.
- Miles B, Tuomela K, Sanchez J. Severe Group C Streptococcus infection in a veterinarian. IDCases 2021;23:e01036.
- Aida Z, Lamia A, Souheil Z, Badreddine K, Monika B, Rim A, Aida B, Hajer H, Hanen TB. Meningitis due to Streptococcus equi in a 73 year old woman with an osteodural defect. IDCases 2020;21:e00779.
- Torpiano P, Nestorova N, Vella C. Streptococcus equi subsp. equi meningitis, septicemia and subdural empyema in a child. IDCases 2020;21:e00808.
- Kjærgaard N, Bodilsen J, Justesen US, Schønheyder HC, Andersen CØ, Ellermann-Eriksen S, Dzajic E, Chen M, Møller JK, Dessau RB, Frimodt-Møller N, Jarløv JO, Nielsen H. Community-acquired meningitis caused by beta-haemolytic streptococci in adults: a nationwide population-based cohort study. Eur J Clin Microbiol Infect Dis 2019 Dec;38(12):2305-2310.
- Zahlanie Y, Almatrafi M, Filkins L, Hsiang MS. Possible canine source of Streptococcus equi subspecies zooepidemicus causing meningitis in an infant. IDCases 2019;17:e00568.
- Clarke M, Enuh H, Saverimuttu J, Nfonoyim J. Streptococcus group C meningitis with cavernous sinus thrombosis. Infect Drug Resist 2013;6:79-81.
- Mori N, Guevara JM, Tilley DH, Briceno JA, Zunt JR, Montano SM. Streptococcus equi subsp. zooepidemicus meningitis in Peru. J Med Microbiol 2013 Feb;62(Pt 2):335-337.
- Stufano A, Schino V, Plantone D, Lucchese G. Occupational zoonoses, neurological diseases, and public health: A one health approach. Infect Med (Beijing) 2025 Jun;4(2):100184.
- Bi D, Luo X, Tang X, Luo X, Mo L. A rare case report of concurrent cryptococcal, streptococcal, and tuberculous meningitis in a patient with pulmonary tuberculosis. Medicine (Baltimore) 2024 Oct 25;103(43):e40276.
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