title: Central nervous system involvement in adult patients with invasive infection caused by Streptococcus agalactiae.
abstract: BACKGROUND
  Streptococcus agalactiae is frequently an asymptomatic coloniser and a cause of neonatal and puerperal sepsis. Infections in nonpregnant adults are uncommon. The frequency of neurological complications caused by invasive infection with this microorganism in adults remains unknown. Here, we study the frequency and characteristics of central nervous system (CNS) involvement in adults with invasive S. agalactiae infection.
  
  
  METHODS
  Review of all adults with invasive S. agalactiae infection between 2003 and 2011 in a tertiary hospital.
  
  
  RESULTS
  S. agalactiae was isolated from blood, CSF or synovial fluid in 75 patients. Among them, 7 (9,3%) displayed neurological involvement: 5 men and 2 nonpregnant women, aged between 20 and 62 years. Diagnoses were spinal epidural abscess due to spondylodiscitis with spinal cord compression; acute bacterial meningitis; ischemic stroke as presentation of bacterial endocarditis (2 patients each); and meningoventriculitis after neurosurgery and ventricular shunting. One patient with endocarditis caused by S. agalactiae and S. aureus died in the acute phase, and another died 3 months later from metastatic cancer. The other patients recovered without sequelae. All patients had systemic predisposing factors for infection and 5 (71,4%) had experienced disruption of the mucocutaneous barrier as a possible origin of the infection.
  
  
  CONCLUSIONS
  CNS involvement is not uncommon in adult patients with invasive infection caused by S. agalactiae. Isolating S. agalactiae, especially in cases of meningitis, should lead doctors to search for predisposing systemic disease and causes of mucocutaneous barrier disruption.
authors.affiliation: Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España.
authors.forename: B
authors.initials: B
authors.lastname: Oyanguren
authors.affiliation: Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España.
authors.forename: L
authors.initials: L
authors.lastname: Esteban
authors.affiliation: Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España.
authors.forename: M
authors.initials: M
authors.lastname: Guillán
authors.affiliation: Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España.
authors.forename: A
authors.initials: A
authors.lastname: de Felipe
authors.affiliation: Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España.
authors.forename: A
authors.initials: A
authors.lastname: Alonso Cánovas
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, España.
authors.forename: E
authors.initials: E
authors.lastname: Navas
authors.affiliation: Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, España.
authors.forename: C
authors.initials: C
authors.lastname: Quereda
authors.affiliation: Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España. Electronic address: icorral.hrc@salud.madrid.org.
authors.forename: I
authors.initials: I
authors.lastname: Corral
mesh_terms: D000328:Adult; D020806:Central Nervous System Bacterial Infections / Q000382:microbiology*; D004697:Endocarditis, Bacterial / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D016920:Meningitis, Bacterial / Q000209:etiology; D008875:Middle Aged; D012189:Retrospective Studies; D013211:Staphylococcus aureus / Q000302:isolation & purification; D013290:Streptococcal Infections / Q000150:complications*; D013292:Streptococcus agalactiae / Q000302:isolation & purification*; D055815:Young Adult
keywords: Absceso epidural espinal; Espondilodiscitis; Ictus; Meningitis; Spinal epidural abscess; Spondylodiscitis; Streptococcus agalactiae; Stroke; Ventriculitis