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Abstract

Group A streptococcus (GAS) is a rare cause of bacterial meningitis in children and is associated with a high cerebral complication rate. In this case report, we present a 9-year-old girl with GAS meningitis complicated with cerebritis. Clear guidelines about choice of treatment and indications of follow-up by imaging tests are lacking, making GAS meningitis unpredictable and difficult to treat. Eventually, we found 25 paediatric cases of GAS meningitis presented in the literature and reviewed their treatment choices, outcomes and follow-up by imaging tests. Penicillin and ceftriaxone are most preferred for the treatment of GAS meningitis and adding rifampicin to the antibiotic treatment could be of potential benefit. When considering the duration of antibiotic treatment and follow-up by imaging tests, no clear recommendations were found. We found that GAS meningitis is associated with higher mortality and cerebral complication rates compared to other, more common, bacterial causes of meningitis in children. This should alert the clinician to consider imaging tests routinely, even if the patient improves clinically. We advise clinicians to routinely evaluate for possible cerebral complications through magnetic resonance imaging (MRI) scans. When cerebral complications are found, antibiotic treatment should be prolonged and adding rifampicin to the antibiotic regime may be considered.

  • This is an open-access article distributed under the terms of the Creative Commons Attribution License.
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2019-11-01
2024-04-24
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References

  1. van Zitteren LM, Arents NL, Halbertsma F. Group-A-streptococcal meningitis in a 7-year-old child - a rare pathogen in a non-immune compromised patient. Case Rep Child Meml Hosp Chic 2011; 2011: [View Article]
    [Google Scholar]
  2. Busetti M, Marchetti F, Croci E, L'erario I, Creti R et al. Group A streptococcal meningitis: a case report. New Microbiol 2013; 36:419–422
    [Google Scholar]
  3. Sommer R, Rohner P, Garbino J, Auckenthaler R, Malinverni R et al. Group A beta-hemolytic Streptococcus meningitis: clinical and microbiological features of nine cases. Clin Infect Dis 1999; 29:929–931 [View Article]
    [Google Scholar]
  4. Paul SP, Jerwood S. Group A streptococcal septicemia, meningitis and cerebral abscess: case report and literature review. Turk J Pediatr 2012; 54:180–183
    [Google Scholar]
  5. Steppberger K, Adams I, Deutscher J, Müller H, Kiess W. Meningitis in a girl with recurrent otitis media caused by Streptococcus pyogenes--otitis media has to be treated appropriately. Infection 2001; 29:286–288 [View Article]
    [Google Scholar]
  6. Murphy DJ. Group A streptococcal meningitis. Pediatrics 1983; 71:
    [Google Scholar]
  7. Walsh M, Chodock R, Quinn C, Peglow S. Group A β-hemolytic streptococcal meningitis associated with uncomplicated varicella. Am J Emerg Med 1994; 12:602–603 [View Article]
    [Google Scholar]
  8. Fanella S, Embree J. Group A streptococcal meningitis in a pediatric patient. Can J Infect Dis Med Microbiol 2008; 19:306–308 [View Article]
    [Google Scholar]
  9. Perera N, Abulhoul L, Green MR, Swann RA. Group A streptococcal meningitis: case report and review of the literature. J Infect 2005; 51:E1–E4 [View Article]
    [Google Scholar]
  10. Berner R, Herdeg S, Gordjani N, Brandis M. Streptococcus pyogenes meningitis: report of a case and review of the literature. Eur J Pediatr 2000; 159:527–529 [View Article]
    [Google Scholar]
  11. Bruun T, Kittang BR, Mylvaganam H, Lund-Johansen M, Skrede S. Clinical, microbiological and molecular characteristics of six cases of group A streptococcal meningitis in Western Norway. Scand J Infect Dis 2010; 42:665–671 [View Article]
    [Google Scholar]
  12. Mathur P, Arora NK, Kapil A, Das BK. Streptococcus pyogenes meningitis. Indian J Pediatr 2004; 71:423–426 [View Article]
    [Google Scholar]
  13. Shetty AK, Frankel LR, Maldonado Y, Falco DA, Lewis DB. Group A streptococcal meningitis: report of a case and review of literature since 1976. Pediatr Emerg Care 2001; 17:430–434 [View Article]
    [Google Scholar]
  14. Moses AE, Beeri M, Engelhard D. Group A streptococcal meningitis: report of two cases. J Infect 1998; 36:116–118 [View Article]
    [Google Scholar]
  15. Arnoni MV, Berezin EN, Sáfadi MAP, Almeida FJ, Lopes CRC. Streptococcus pyogenes meningitis in children: report of two cases and literature review. Braz J Infect Dis 2007; 11:375–377 [View Article]
    [Google Scholar]
  16. de Almeida Torres RSL, Fedalto LE, de Almeida Torres RF, Steer AC, Smeesters PR. Group A Streptococcus meningitis in children. Pediatr Infect Dis J 2013; 32:110–114 [View Article]
    [Google Scholar]
  17. Uppal L, Singhi S, Singhi P, Aggarwal R. Role of rifampin in reducing inflammation and neuronal damage in childhood bacterial meningitis: a pilot randomized controlled trial. Pediatr Infect Dis J 2017; 36:556–559 [View Article]
    [Google Scholar]
  18. Jagdis F. Group A streptococcal meningitis and brain abscess. Pediatr Infect Dis J 1988; 7:885–886
    [Google Scholar]
  19. Capua T, Klivitsky A, Bilavsky E, Ashkenazi-Hoffnung L, Roth J et al. Group A Streptococcal brain abscess in the pediatric population - case series and review of the literature. Pediatr Infect Dis J 2018; 1:
    [Google Scholar]
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