title: Group A Streptococcal meningitis in adults.
abstract: OBJECTIVE
  We report on the incidence, clinical characteristics, and bacterial genotype of group A streptococcal (GAS) meningitis in the Netherlands.
  
  
  METHODS
  We assessed the incidence, clinical characteristics, and outcome of patients with GAS meningitis from a nationwide cohort study of adults with community-acquired bacterial meningitis in the Netherlands from 2006 to 2013.
  
  
  RESULTS
  GAS was identified in 26 of 1322 patients with community-acquired bacterial meningitis (2%); 9 cases (35%) occurred in the first four months of 2013. GAS meningitis was often preceded by otitis or sinusitis (24 of 26 [92%]) and a high proportion of patients developed complications during clinical course (19 of 26 [73%]). Subdural empyema occurred in 8 of 26 patients (35%). Nine patients underwent mastoidectomy and in 5 patients neurosurgical evacuation of the subdural empyema was performed. Five of 26 patients (19%) died and 11 of 21 surviving patient had neurologic sequelae (52%). Infection with the emm1 and cc28 GAS genotype was associated with subdural empyema (both 4 of 6 [67%] vs. 2 of 14 [14%]; P = 0.037).
  
  
  CONCLUSIONS
  GAS meningitis is an uncommon but severe disease. Patients are at risk for empyema, which is associated with infection with the emm1 and cc28 genotype.
authors.affiliation: Academic Medical Center, Center of Infection and Immunity Amsterdam (CINIMA), Department of Neurology, PO Box 22660, 1100DD Amsterdam, The Netherlands.
authors.forename: Marjolein J
authors.initials: MJ
authors.lastname: Lucas
authors.affiliation: Academic Medical Center, Center of Infection and Immunity Amsterdam (CINIMA), Department of Neurology, PO Box 22660, 1100DD Amsterdam, The Netherlands.
authors.forename: Matthijs C
authors.initials: MC
authors.lastname: Brouwer
authors.affiliation: Academic Medical Center, Center of Infection and Immunity Amsterdam (CINIMA), Department of Medical Microbiology, PO Box 22660, 1100DD Amsterdam, The Netherlands; The Netherlands Reference Laboratory for Bacterial Meningitis, Academic Medical Center, PO Box 22660, 1100DD Amsterdam, The Netherlands.
authors.forename: Sandra
authors.initials: S
authors.lastname: Bovenkerk
authors.affiliation: Academic Medical Center, Center of Infection and Immunity Amsterdam (CINIMA), Department of Medical Microbiology, PO Box 22660, 1100DD Amsterdam, The Netherlands; The Netherlands Reference Laboratory for Bacterial Meningitis, Academic Medical Center, PO Box 22660, 1100DD Amsterdam, The Netherlands.
authors.forename: Wing Kit
authors.initials: WK
authors.lastname: Man
authors.affiliation: Academic Medical Center, Center of Infection and Immunity Amsterdam (CINIMA), Department of Medical Microbiology, PO Box 22660, 1100DD Amsterdam, The Netherlands; The Netherlands Reference Laboratory for Bacterial Meningitis, Academic Medical Center, PO Box 22660, 1100DD Amsterdam, The Netherlands.
authors.forename: Arie
authors.initials: A
authors.lastname: van der Ende
authors.affiliation: Academic Medical Center, Center of Infection and Immunity Amsterdam (CINIMA), Department of Neurology, PO Box 22660, 1100DD Amsterdam, The Netherlands. Electronic address: d.vandebeek@amc.uva.nl.
authors.forename: Diederik
authors.initials: D
authors.lastname: van de Beek
mesh_terms: D000328:Adult; D017714:Community-Acquired Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D004653:Empyema / Q000453:epidemiology / Q000382:microbiology / Q000473:pathology; D005260:Female; D005838:Genotype; D006801:Humans; D015994:Incidence; D008297:Male; D016920:Meningitis, Bacterial / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D013290:Streptococcal Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology; D013297:Streptococcus pyogenes / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D016896:Treatment Outcome
keywords: Complications; Empyema; Group A streptococcus; Meningitis; incidence