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