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

Nicolai Kjærgaard*, 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, DASGIB study group, Lykke Larsen (Member of author group)

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

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.

Original languageEnglish
JournalEuropean journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology
Volume38
Issue number12
Pages (from-to)2305-2310
ISSN0934-9723
DOIs
Publication statusPublished - Dec 2019

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