title: Streptococcus agalactiae septicemia in a patient with diabetes and hepatic cirrhosis.
abstract: Streptococcus agalactiae is a well-known pathogen during pregnancy and in neonates. Among non-pregnant adults, invasive infection, although rare, is showing increasing frequency, especially in chronically ill, immunosuppressed, or older patients. Although rare, the clinical features of meningeal infection caused by S. agalactiae are similar to other bacterial meningitis. The authors report the case of a middle-aged man previously diagnosed with hypertension, diabetes mellitus, and alcoholic liver cirrhosis, who was admitted at the emergency department with a Glasgow Coma Scale of 11/12, generalized spasticity, bilateral Babinski sign, and hypertension. The clinical outcome was bad, with refractory shock and death within 24 hours of hospitalization. The bacteriological work-up isolated S. agalactiae in the cerebral spinal fluid (CSF), blood, and urine. An autopsy revealed meningoencephalitis, acute myocardial infarction, and pyelonephritis due to septic emboli. The authors point out the atypical CSF findings, the rapid fatal outcome, and the importance of including this pathogen among the etiologic possibilities of invasive infections in this group of patients.
authors.affiliation: Department of Pathology - Faculty of Medicine - University of São Paulo, São Paulo/SP - Brazil .
authors.forename: Renan Pedroso
authors.initials: RP
authors.lastname: Batista
authors.affiliation: Anatomic Pathology Service - Hospital Universitário - University of São Paulo, São Paulo/SP - Brazil .
authors.forename: Cristiane Rúbia
authors.initials: CR
authors.lastname: Ferreira
keywords: Autopsy; Bacterial; Meningitis; Sepsis; Streptococcus agalactiae