title: Diffusion-weighted MRI abnormalities in an outbreak of Streptococcus agalactiae Serotype III, multilocus sequence type 283 meningitis.
abstract: In 2015, an outbreak of group B streptococcal (GBS) infection caused by Streptococcus agalactiae Serotype III, multilocus sequence type 283, related to consuming infected raw freshwater fish, affected more than 200 patients in Singapore. We describe the clinical, laboratory, and neuroimaging features of a subgroup of adults with central nervous system (CNS) infections caused by GBS.
  
  
  
  The database of the Singapore Neurologic Infections Program (SNIP), a national multicenter study for surveillance of infectious neurologic disease, was reviewed to select patients with GBS CNS infection during the outbreak. Cases were diagnosed on the basis of clinical features, cerebrospinal fluid (CSF) findings and identification or isolation of Streptococcus agalactiae in the blood or CSF. Demographic, clinical and neuroradiological information was obtained prospectively and retrospectively abstracted.
  
  
  
  Fourteen patients (6 male, 8 female; median age, 58 years) presented with fever, meningism, headache, encephalopathy, focal neurological deficits, and/or seizures. All except two were previously healthy. Diffusion-weighted imaging (DWI) on admission was abnormal in 13 patients, showing tiny hyperintensities in the subarachnoid space (7 patients), ventricles (6 patients) and brain parenchyma (8 patients); 5 patients had cerebellar abnormalities.
  
  
  
  Among healthy non-pregnant adults infected with Serotype III, multilocus sequence type 283 GBS meningitis linked to eating infected raw freshwater fish, DWI detected small pus collections and unusual cerebellar involvement. A collaborative national surveillance system that includes MRI can be helpful during unusual food-borne zoonotic infectious disease outbreaks.
  
  
  
  4 J. Magn. Reson. Imaging 2017;45:507-514.
authors.affiliation: Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital Campus), Singapore.|Duke-NUS Graduate Medical School, Singapore.
authors.forename: Kevin
authors.initials: K
authors.lastname: Tan
authors.affiliation: Department of Infectious Disease, Singapore General Hospital, Singapore.
authors.forename: Limin
authors.initials: L
authors.lastname: Wijaya
authors.affiliation: Department of Neurology, National Neuroscience Institute (Tan Tock Seng Hospital Campus), Singapore.
authors.forename: Hui-Jin
authors.initials: HJ
authors.lastname: Chiew
authors.affiliation: Duke-NUS Graduate Medical School, Singapore.|Department of Neuroradiology, National Neuroscience Institute (Tan Tock Seng Hospital Campus), Singapore.
authors.forename: Yih-Yian
authors.initials: YY
authors.lastname: Sitoh
authors.affiliation: Department of Medicine, Division of Infectious Diseases, Changi General Hospital, Singapore.
authors.forename: Humaira
authors.initials: H
authors.lastname: Shafi
authors.affiliation: Duke-NUS Graduate Medical School, Singapore.|Department of Diagnostic Radiology, Singapore General Hospital, Singapore.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Chen
authors.affiliation: Department of Radiology, Changi General Hospital, Singapore.
authors.forename: Chin Kong
authors.initials: CK
authors.lastname: Goh
authors.affiliation: Duke-NUS Graduate Medical School, Singapore.|Department of Neuroradiology, National Neuroscience Institute (Tan Tock Seng Hospital Campus), Singapore.
authors.forename: C C Tchoyoson
authors.initials: CC
authors.lastname: Lim
mesh_terms: D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D004196:Disease Outbreaks / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D000069544:Infectious Encephalitis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D008297:Male; D016920:Meningitis, Bacterial / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012846:Singapore / Q000453:epidemiology; D013290:Streptococcal Infections / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D013292:Streptococcus agalactiae
keywords: Group B Streptococcus; Streptococcus agalactiae; meningitis; outbreak; stroke