Community-acquired meningitis caused by beta-haemolytic streptococci in adults: a nationwide population-based cohort study

  • Nicolai KjærgaardEmail author
  • Jacob Bodilsen
  • Ulrik Stenz Justesen
  • Henrik Carl Schønheyder
  • Christian Østergaard Andersen
  • Svend Ellermann-Eriksen
  • Esad Dzajic
  • Ming Chen
  • Jens Kjølseth Møller
  • Ram Benny Dessau
  • Niels Frimodt-Møller
  • Jens Otto Jarløv
  • Henrik Nielsen
  • the DASGIB Study Group
Original Article


The objective of this study was to examine the clinical presentation of community-acquired beta-haemolytic streptococcal (BHS) meningitis in adults. This is a nationwide population-based cohort study of adults (≥ 16 years) with BHS meningitis verified by culture or polymerase chain reaction of the cerebrospinal fluid (CSF) from 1993 to 2005. We retrospectively evaluated clinical and laboratory features and assessed outcome by Glasgow Outcome Scale (GOS). We identified 54 adults (58% female) with a median age of 65 years (IQR 55–73). Mean incidence rate was 0.7 cases per 1,000,000 person-years. Alcohol abuse was noted among 11 (20%) patients. Group A streptococci (GAS) were found in 17 (32%) patients, group B (GBS) in 18 (34%), group C (GCS) in four (8%) and group G (GGS) in 14 (26%). Patients with GAS meningitis often had concomitant otitis media (47%) and mastoiditis (30%). Among patients with GBS, GCS or GGS meningitis, the most frequent concomitant focal infections were bone and soft tissue infections (19%) and endocarditis (16%). In-hospital mortality was 31% (95% CI 19–45), and 63% (95% CI 49–76) had an unfavourable outcome at discharge (GOS < 5). BHS meningitis in adults is primarily observed among the elderly and has a poor prognosis. GAS meningitis is primarily associated with concomitant ear-nose-throat infection.


Bacterial meningitis Beta-haemolytic streptococci Streptococcus pyogenes Streptococcus agalactiae Streptococcus dysgalactiae Epidemiology Prognosis Outcome 



We would like to thank members of the Danish Study Group for Infections in the Brain: Christian Østergaard (Hvidovre Hospital), Christian Brandt (Hillerød Hospital), Birgitte Rønde Hansen (Hvidovre Hospital), Jannik Helweg-Larsen (Rigshospitalet), Lothar Wiese (Roskilde Hospital), Lykke Larsen (Odense University Hospital) and Merete Storgaard (Aarhus University Hospital).

Compliance with ethical standards

Before data collection, the project was approved by the Danish Data Protection Agency (record no. 2008-58-0028, local ID-number 2017-218) and the Danish Board of Health (record no. 3-3013-2365/1). Acceptance from a research ethics committee is not required for this type of study in Denmark.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

10096_2019_3678_MOESM1_ESM.docx (17 kb)
ESM 1 (DOCX 17 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Nicolai Kjærgaard
    • 1
    Email author
  • Jacob Bodilsen
    • 1
  • Ulrik Stenz Justesen
    • 2
  • Henrik Carl Schønheyder
    • 3
  • Christian Østergaard Andersen
    • 4
  • Svend Ellermann-Eriksen
    • 5
  • Esad Dzajic
    • 6
  • Ming Chen
    • 7
  • Jens Kjølseth Møller
    • 8
  • Ram Benny Dessau
    • 9
  • Niels Frimodt-Møller
    • 10
  • Jens Otto Jarløv
    • 11
  • Henrik Nielsen
    • 1
    • 12
  • the DASGIB Study Group
  1. 1.Department of Infectious DiseaseAalborg University HospitalAalborgDenmark
  2. 2.Department of Clinical MicrobiologyOdense University HospitalOdenseDenmark
  3. 3.Department of Clinical MicrobiologyAalborg University HospitalAalborgDenmark
  4. 4.Department of Clinical MicrobiologyHvidovre HospitalHvidovreDenmark
  5. 5.Department of Clinical MicrobiologyAarhus University HospitalAarhus NDenmark
  6. 6.Department of Clinical MicrobiologySydvestjysk SygehusEsbjergDenmark
  7. 7.Department of Clinical MicrobiologyHospital of Southern JutlandSonderborgDenmark
  8. 8.Department of Clinical MicrobiologySygehus LillebæltVejleDenmark
  9. 9.Department of Clinical MicrobiologySlagelse HospitalSlagelseDenmark
  10. 10.Department of Clinical MicrobiologyRigshospitaletCopenhagenDenmark
  11. 11.Department of Clinical MicrobiologyHerlev HospitalHerlevDenmark
  12. 12.Department of Clinical MedicineAalborg UniversityAalborgDenmark

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