title: A case of meningitis caused by Streptococcus pyogenes in a previously healthy woman.
abstract: BACKGROUND
  Streptococcus pyogenes is a well-known cause of a variety of clinical infections including local symptoms such as tonsillopharyngitis, cervical lymphadenitis, otitis media, cellulites, erysipelas, as well as more severe diseases such as scarlet fever, osteomyelitis, necrotizing fasciitis, sepsis, and toxic shock syndrome. However, acute bacterial meningitis caused by this pathogen is unusual.
  
  
  OBJECTIVE
  We report a case of group A streptococcus (GAS) meningitis in a previously healthy woman with a dramatically rapid course and fatal outcome.
  
  
  METHODS
  A 41-year-old previously healthy woman presented a history of fever, headache, vomiting, and sore throat of three days' duration. Neurological examination revealed diminished consciousness and neck rigidity. The cerebrospinal fluid (CSF) was turbid with 10,000 leukocytes/mm(3). Direct examination of CSF showed Gram-positive cocci in chains, and cultures yielded S. pyogenes. Blood cultures yielded growth of S. pyogenes. The patient was treated initially with ceftriaxone (4 g/day) and the control CSF examination was not changed on the third day, so vancomycin (2 g/day) was added to the treatment; however, she died on the fourth day of the treatment.
  
  
  CONCLUSIONS
  S. pyogenes meningitis is uncommon and the incidence seems to be persistently low; nevertheless, clinicians should be aware that sporadic cases may occur and may have a fulminant course with a relevant neurological sequel.
authors.affiliation: Midyat State Hospital, Department of Infectious Diseases and Clinic Microbiology, 47100 Mardin, Turkey. mehmetulug21@yahoo.com
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ulug
authors.forename: Nuray Can
authors.initials: NC
authors.lastname: Ulug
authors.forename: Mustafa Kemal
authors.initials: MK
authors.lastname: Celen
authors.forename: Mehmet Faruk
authors.initials: MF
authors.lastname: Geyik
authors.forename: Celal
authors.initials: C
authors.lastname: Ayaz
mesh_terms: D000328:Adult; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D016920:Meningitis, Bacterial / Q000175:diagnosis* / Q000382:microbiology; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000382:microbiology; D013297:Streptococcus pyogenes / Q000302:isolation & purification*