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Home / Equine Research Bank / IDCases / Streptococcus equi subsp. equi meningitis, septicemia and su...
IDCases2020; 21; e00808; doi: 10.1016/j.idcr.2020.e00808

Streptococcus equi subsp. equi meningitis, septicemia and subdural empyema in a child.

Abstract: Streptococcus equi subsp. equi is a group C β-hemolytic streptococcus, and is an invasive pathogen with a very restricted host, causing the equine infection known as 'strangles'. It is a poor colonizer in horses, preferentially causing invasion and infection, compared with its ancestor Streptococcus equi subsp. zooepidemicus, which is considered an opportunistic commensal of the equine upper respiratory tract. In humans, S. equi subsp. equi causes invasive infections in immunocompromised hosts, often following close contact with horses. Such infections are associated with a high mortality, as well as a poor neurological outcome in survivors. Beta-lactam antimicrobials form the mainstay of treatment, while neurosurgical intervention is occasionally required. We present the case of a 13-year old boy with systemic lupus erythematosus being treated with hydroxychloroquine, who presented with S. equi subsp. equi meningitis and sepsis after contact with a sick pony. Although he recovered fully following eight weeks of intravenous ceftriaxone and oral rifampin, the clinical course was complicated by subdural empyema requiring neurosurgical evacuation.
© 2020 Published by Elsevier Ltd.
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Publication Date: 2020-05-14 PubMed ID: 32489871PubMed Central: PMC7256365DOI: 10.1016/j.idcr.2020.e00808Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

This article outlines the case of a 13-year-old boy with an autoimmune disease, who developed a severe infection through a bacterium often associated with horses. The infection led to meningitis, septicemia, and subdural empyema, necessitating extended treatment with antibiotics and surgery.

Disease Pathogen and Its Effect

  • Streptococcus equi subsp. equi (S. equi equi) is a specific type of group C beta-hemolytic streptococcus, a bacterium typically found causing an infection in horses known as strangles.
  • Unlike its ancestor bacteria Streptococcus equi subsp., S.equi equi has a focused host range and favours invasion and infection over colonization. This means it tends to cause severe diseases in its host rather than set up a mutually beneficial relationship.
  • Infection with this bacterium in humans is uncommon, requiring close contact with horses. It finds fertile grounds especially in people with compromised immune systems.
  • One alarming characteristic of S. equi equi is its association with high mortality and poor neurological outcome in those who survive the infection.
  • The primary treatment is with beta-lactam antimicrobials, a class of antibiotics. In some severe cases, neurosurgical intervention might be required.

Case Report: Disease Presentation and Treatment in an Immunosuppressed Child

  • The report presents the case of a 13-year-old boy with systemic lupus erythematosus (SLE), an autoimmune disease, for which he was being treated with hydroxychloroquine, a medication that can suppress the immune system.
  • Post contact with a sick pony, the boy developed meningitis and septicemia due to S. equi equi. Meningitis is an inflammation of the protective membranes covering the brain and spinal cord, while septicemia is a serious bloodstream infection. Both illnesses can be life-threatening.
  • The patient required extensive treatment which included eight weeks of intravenous ceftriaxone and oral rifampin, both potent antibiotics. The antibiotics form the mainstay of the treatment for S. equi equi infections.
  • A complication of the infection was the development of subdural empyema, a condition where pus collects between the layers of the brain. This required neurosurgical drainage, indicative of the severity of the illness.
  • Despite the severity of his condition and complications, the boy made a full recovery.

Cite This Article

APA
Torpiano P, Nestorova N, Vella C. (2020). Streptococcus equi subsp. equi meningitis, septicemia and subdural empyema in a child. IDCases, 21, e00808. https://doi.org/10.1016/j.idcr.2020.e00808

Publication

IDCases
ISSN: 2214-2509
NlmUniqueID: 101634540
Country: Netherlands
Language: English
Volume: 21
Pages: e00808

Researcher Affiliations

Torpiano, Paul
  • Department of Paediatrics and Adolescent Health, Mater Dei Hospital, Triq id-Donaturitad-Demm, MSD2090 Tal-Qroqq, Malta.
Nestorova, Nina
  • Department of Pathology, Mater Dei Hospital, Triq id-Donaturitad-Demm, MSD2090 Tal-Qroqq, Malta.
Vella, Cecil
  • Department of Paediatrics and Adolescent Health, Mater Dei Hospital, Triq id-Donaturitad-Demm, MSD2090 Tal-Qroqq, Malta.

Conflict of Interest Statement

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Citations

This article has been cited 10 times.
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