title: Clinical, microbiological and molecular characteristics of six cases of group A streptococcal meningitis in western Norway.
abstract: Meningitis is a rare clinical manifestation of invasive group A streptococcal (iGAS) disease. Clinical, microbiological and molecular characteristics of 6 consecutive cases of GAS meningitis treated in Haukeland University Hospital in the period 2004-2009 are described. All 6 patients had a primary upper respiratory tract infection, with subsequent mastoiditis in 5, subdural effusions in 2, and cerebral abscess in 1. Five patients needed surgical treatment (myringotomy, craniotomy or mastoidectomy). All patients were treated with a beta-lactam antibiotic in combination with rifampicin. The course was complicated in all cases, and 1 patient died. Three of the bacterial isolates were of the sequence type emm1.0 and they shared the same superantigen gene profile (speA, speG, speJ, smeZ). The remaining 3 isolates belonged to sequence types emm 3.1, emm6.4 and emm12.0. Deletions in emm genes were observed. This report describes the severe and complicated course of GAS meningitis and its management, often requiring surgical intervention.
authors.affiliation: Department of Medicine, Haukeland University Hospital, Bergen, Norway.
authors.forename: Trond
authors.initials: T
authors.lastname: Bruun
authors.forename: Bård Reiakvam
authors.initials: BR
authors.lastname: Kittang
authors.forename: Haima
authors.initials: H
authors.lastname: Mylvaganam
authors.forename: Morten
authors.initials: M
authors.lastname: Lund-Johansen
authors.forename: Steinar
authors.initials: S
authors.lastname: Skrede
mesh_terms: D000293:Adolescent; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D000942:Antigens, Bacterial / Q000235:genetics; D001425:Bacterial Outer Membrane Proteins / Q000235:genetics; D002352:Carrier Proteins / Q000235:genetics; D002648:Child; D005260:Female; D017353:Gene Deletion; D006801:Humans; D008297:Male; D008417:Mastoiditis / Q000188:drug therapy / Q000382:microbiology; D016920:Meningitis, Bacterial / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009664:Norway; D012293:Rifampin / Q000494:pharmacology / Q000627:therapeutic use; D013290:Streptococcal Infections / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D013297:Streptococcus pyogenes / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification; D018089:Superantigens / Q000235:genetics; D047090:beta-Lactams / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D000942:Antigens, Bacterial; D001425:Bacterial Outer Membrane Proteins; D002352:Carrier Proteins; D018089:Superantigens; D047090:beta-Lactams; C014689:streptococcal M protein; D012293:Rifampin