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      Meningitis from invasive Streptococcus agalactiae in a healthy young adult

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          Abstract

          Streptococcus agalactiae is well known to be a potential etiology of bacterial meningitis in neonates. Invasive S. agalactiae has been also reported in nonpregnant adults. Among adults, the incidence of invasive group B Streptococcus (GBS) has been increasing 2–4 times in the past 2 decades. Chronic medical disease was suspected to increase the susceptibility for invasive GBS, especially diabetes mellitus. There was only one case reported to have GBS meningitis from acute otitis media infection in otherwise healthy individual. Hereby, we are reporting the second invasive GBS meningitis from acute otitis media infection with mastoiditis.

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          Increasing burden of invasive group B streptococcal disease in nonpregnant adults, 1990-2007.

          Lee Harrison, Janet Mohle-Boetani, Sonia B Albanese … (2009)
          Group B Streptococcus (GBS), traditionally considered to be a neonatal pathogen, is an important cause of morbidity and mortality among older adults and among those with underlying medical conditions. We used population-based surveillance to examine trends in adult GBS disease during the period 1990-2007 and to describe the epidemiology of adult GBS disease to guide prevention efforts. Active Bacterial Core surveillance was conducted in selected counties in 10 US states. A case was defined as isolation of GBS from a normally sterile site in a nonpregnant resident of a surveillance area who was 18 years of age. Rates were calculated using US Census data. Demographic and clinical information was abstracted from medical records. Serotyping and susceptibility testing were performed on isolates collected from a subset of case patients. A total of 19,512 GBS cases were identified in nonpregnant adults during 1990-2007 (median patient age, 63 years); the incidence of adult GBS disease doubled from 3.6 cases per 100,000 persons during 1990 to 7.3 cases per 100,000 persons during 2007 (P < .001). The mean difference in incidence between black and white persons was 4.6 cases per 100,000 persons (range, 3.1 cases per 100,000 persons during 1991 to 5.8 cases per 100,000 persons during 1999). Common clinical syndromes in 2007 included bacteremia without focus (39.3%), skin and/or soft-tissue infection (25.6%), and pneumonia (12.6%). Most (88.0%) GBS cases in adults had 1 underlying condition; diabetes was present in 44.4% of cases. Serotypes V, Ia, II, and III accounted for 80.8% of infections during 1998-1999 and 78.5% of infections during 2005-2006. Invasive GBS disease in nonpregnant adults represents a substantial and increasing burden, particularly among older persons, black persons, and adults with diabetes. Prevention strategies are needed.
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            Group B streptococcal infections in elderly adults.

            Jeremy Edwards, David Baker (2005)
            Elderly adults account for >40% of persons with invasive group B streptococcal (GBS) disease and for >50% of GBS-associated deaths in the United States. The prevalence of colonization among healthy elderly adults (approximately 25%) is similar to that among women of childbearing age. Delineating contributions of comorbid conditions, altered integrity of anatomical barriers, and abnormalities in immune responses caused by immune senescence to pathogenesis require further investigation. Delayed clinical recognition of illness may contribute to poor outcome. Skin and soft-tissue infections and bacteremia with no identified focus are common manifestations of infection in elderly adults and younger nonpregnant adults. Urinary tract infection and pneumonia are presentations more often encountered in elderly persons than in younger adults. The safety and immunogenicity of GBS serotype V-tetanus toxoid conjugate vaccine in healthy elderly persons suggest the potential for vaccination as an approach to prevention of invasive GBS infections in elderly persons.
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              Group B Streptococcus (Streptococcus agalactiae)

              Vanessa Raabe, Andi L Shane (2019)
              Invasive disease due to group B Streptococcus infection ( Streptococcus agalactiae) results in a wide spectrum of clinical disease. In North America, serotypes Ia, Ib, II, III, and V are most frequently associated with invasive disease. Group B Streptococcus remains a continued source of morbidity and mortality in high-risk populations, including pregnant women, neonates, and the elderly; an increasing incidence of invasive disease has been observed in non-pregnant adults. Group B Streptococcus remains the most common culture-confirmed neonatal bacterial infection in the United States and is a significant source of neonatal morbidity globally. Intrapartum antibiotic prophylaxis has reduced the incidence of early onset neonatal disease without a notable impact on the incidence of late onset neonatal disease. Penicillin G remains the mainstay of therapy although reduced penicillin susceptibility has been observed in select isolates. Increased frequency of resistance to non-beta-lactam antibiotics, including clindamycin, erythromycin, and fluoroquinolones, has been observed with some isolates demonstrating resistance to vancomycin. The development and implementation of strategies to identify hosts, treat judiciously with antimicrobials with the narrowest spectra, and prevent invasive disease, with vaccines, are essential to reduce the burden of group B Streptococcus disease.
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                Author and article information

                Contributors
                Steven Douedi
                Journal
                Journal ID (nlm-ta): IDCases
                Journal ID (iso-abbrev): IDCases
                Title: IDCases
                Publisher: Elsevier
                ISSN (Electronic): 2214-2509
                Publication date PMC-release: 07 July 2020
                Publication date Collection: 2020
                Publication date (Electronic): 07 July 2020
                Volume: 21
                Electronic Location Identifier: e00907
                Affiliations
                [a ]Department of Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
                [b ]Department of Infectious Disease, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
                [c ]Department of Pulmonology and Critical Care, Jersey Shore University Medical Center, Neptune, NJ 07753, USA
                Author notes
                [* ]Corresponding author at: Department of Internal Medicine, Jersey Shore University Medical Center, Neptune, NJ 07753, USA. Steven.Douedi@ 123456Hackensackmeridian.org
                Article
                Publisher ID: S2214-2509(20)30215-8 Publisher ID: e00907
                DOI: 10.1016/j.idcr.2020.e00907
                PMC ID: 7355716
                SO-VID: 7aa403c1-c3b0-4b27-b6bc-e28d363c0870
                Copyright © © 2020 The Authors
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 29 June 2020
                Date revision received : 2 July 2020
                Date accepted : 3 July 2020
                Categories
                Subject: Article

                Keywords: group b streptococcus,streptococcus agalactiae,acute otitis media,mastoiditis,meningitis
                Data availability:
                Keywords: group b streptococcus, streptococcus agalactiae, acute otitis media, mastoiditis, meningitis

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