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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.

References

This article includes 14 references
  1. Rajasekhar A, Clancy CJ. Meningitis due to group C Streptococcus: a case report and review of the literature.. Scand. J. Infect. Dis. 2010;42:571–578.
    doi: 10.3109/00365541003754428pubmed: 20632899google scholar: lookup
  2. Waller AS, Paillot R, Timoney JF. Streptococcus equi: a pathogen restricted to one host.. J Med. Microbiol. 2011;60:1231–1240.
    doi: 10.1099/jmm.0.028233-0pubmed: 21757503google scholar: lookup
  3. Pelkonen S, Lindahl SB, Suomala P. Transmission of Streptococcus equi subspecies zooepidemicus infection from horses to humans.. Emerg. Infect. Dis. 2013;19:1041–1048.
    doi: 10.3201/eid1907.121365pmc: PMC3713971pubmed: 23777752google scholar: lookup
  4. van Samkar A, Brouwer MC, van der Ende A, van de Beek D. Streptococcus equi meningitis.. Clin. Microbiol. Infect. 2016;22(1):e3–e4.
    doi: 10.1016/j.cmi.2015.09.003pubmed: 26369601google scholar: lookup
  5. Elsayed S, Hammerberg O, Massey V, Hussain Z. Streptococcus equi subspecies equi (Lancefield group C) meningitis in a child.. Clin. Microbiol. Infect. 2003;9:869–872.
    pubmed: 14616711
  6. Shah SS, Matthews RP, Cohen C. Group C streptococcal meningitis: case report and review of the literature.. Pediatr. Infect. Dis. J. 2001;20:445–448.
    pubmed: 11332674
  7. Popescu G-A, Fuerea R, Benea E. Meningitis due to an unusual human pathogen: Streptococcus equi subspecies equi.. South Med. J. 2006;99:190–191.
    doi: 10.1097/01.smj.0000198265.82867.a3pubmed: 16509563google scholar: lookup
  8. Zahlanie Y, Almatrafi M, Filkins L, Hsiang MS. Possible canine source of Streptococcus equi subspecies zooepidemicus causing meningitis in an infant.. IDCases 2019;17.
    doi: 10.1016/j.idcr.2019.e00568pmc: PMC6555896pubmed: 31194131google scholar: lookup
  9. Jovanovic M, Stevanovic G, Tosic T, Stosovic B, Zervos MJ. Streptococcus equi subsp. Zooepidemicus meningitis.. J. Med. Microbiol. 2008;57:373–375.
    doi: 10.1099/jmm.0.47487-0pubmed: 18287302google scholar: lookup
  10. Eyre DW, Kenkre J, Bowler ICJW, McBride SJ. Streptococcus equi subspecies zooepidemicus meningitis—a case report and review of the literature.. Eur. J. Clin. Microbiol. Infect. Dis. 2010;29:1459–1463.
    doi: 10.1007/s10096-010-1037-5pubmed: 20820836google scholar: lookup
  11. Brouwer MC, Kasanmoentalib ES, Opstelten FW, van der Ende A, van de Beek D. A horse bite to remember.. Lancet 2010;376:1194.
    doi: 10.1016/S0140-6736(10)60965-8pubmed: 20888995google scholar: lookup
  12. Mori N, Guevara JM, Tilley DH, Briceno JA, Zunt JR, Montano SM. Streptococcus equi subsp. Zooepidemicus meningitis in Peru.. J. Med. Microbiol. 2013;62:335–337.
    doi: 10.1099/jmm.0.050245-0pmc: PMC3709539pubmed: 23105024google scholar: lookup
  13. Madžar D, Hagge M, Möller S. Endogenous endophthalmitis complicating Streptococcus equi subspecies zooepidemicus meningitis: a case report.. BMC Res. Notes 2015;8:184.
    doi: 10.1186/s13104-015-1133-9pmc: PMC4423494pubmed: 25940309google scholar: lookup
  14. Minces LR, Brown PJ, Veldkamp PJ. Human meningitis from Streptococcus equi subsp. Zooepidemicus acquired as zoonoses.. Epidemiol. Infect. 2011;139:406–410.
    doi: 10.1017/S0950268810001184pubmed: 20492747google scholar: lookup

Citations

This article has been cited 10 times.
  1. 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.
    doi: 10.1097/MD.0000000000040276pubmed: 39470512google scholar: lookup
  2. Zu H, Sun R, Li J, Guo X, Wang M, Guo W, Wang X. Development of a Real-Time Recombinase-Aided Amplification Method for the Rapid Detection of Streptococcus equi subsp. equi. Microorganisms 2024 Apr 11;12(4).
    doi: 10.3390/microorganisms12040777pubmed: 38674721google scholar: lookup
  3. 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.
    doi: 10.1186/s12941-023-00602-1pubmed: 37533031google scholar: lookup
  4. 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.
    doi: 10.1371/journal.pone.0284869pubmed: 37115801google scholar: lookup
  5. Shikina EV, Kovalevsky RA, Shirkovskaya AI, Toukach PV. Prospective bacterial and fungal sources of hyaluronic acid: A review. Comput Struct Biotechnol J 2022;20:6214-6236.
    doi: 10.1016/j.csbj.2022.11.013pubmed: 36420162google scholar: lookup
  6. Waśniewska-Włodarczyk A, Pepaś R, Janowicz R, Konopka W. Streptococcus equi subsp. equi in Retropharyngeal Abscess: Case Report and Review of Literature. Microorganisms 2022 Oct 14;10(10).
    doi: 10.3390/microorganisms10102032pubmed: 36296308google scholar: lookup
  7. 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.
    doi: 10.1155/2021/7227054pubmed: 34631173google scholar: lookup
  8. 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.
    doi: 10.7759/cureus.17286pubmed: 34552827google scholar: lookup
  9. Arafa AA, Hedia RH, Ata NS, Ibrahim ES. Vancomycin resistant Streptococcus equi subsp. equi isolated from equines suffering from respiratory manifestation in Egypt. Vet World 2021 Jul;14(7):1808-1814.
    doi: 10.14202/vetworld.2021.1808-1814pubmed: 34475702google scholar: lookup
  10. 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.
    doi: 10.1155/2021/9898364pubmed: 34306778google scholar: lookup
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