Clinical, microbiological and molecular characteristics of six cases of group A streptococcal meningitis in western Norway

Abstract

Meningitis is a rare clinical manifestation of invasive group A streptococcal (iGAS) disease. Clinical, microbiological and molecular characteristics of 6 consecutive cases of GAS meningitis treated in Haukeland University Hospital in the period 2004–2009 are described. All 6 patients had a primary upper respiratory tract infection, with subsequent mastoiditis in 5, subdural effusions in 2, and cerebral abscess in 1. Five patients needed surgical treatment (myringotomy, craniotomy or mastoidectomy). All patients were treated with a β-lactam antibiotic in combination with rifampicin. The course was complicated in all cases, and 1 patient died. Three of the bacterial isolates were of the sequence type emm1.0 and they shared the same superantigen gene profile (speA, speG, speJ, smeZ). The remaining 3 isolates belonged to sequence types emm 3.1, emm6.4 and emm12.0. Deletions in emm genes were observed. This report describes the severe and complicated course of GAS meningitis and its management, often requiring surgical intervention.

Acknowledgements

We wish to thank Nina Langeland, at the Faculty of Medicine and Dentistry, University of Bergen, for helpful discussions. We also wish to thank Dag Harald Skutlaberg, at the Department of Microbiology, Haukeland University Hospital, and Øistein Løvoll, at the Norwegian Institute of Public Health, for providing local and national epidemiological data, respectively. The study was supported by the Institute of Medicine, University of Bergen. The study was approved by the Regional Committee of Medical Research Ethics of the West of Norway Health Region.

Declaration of interest: None of the authors are aware of any conflict of interest that may affect professional judgement in relation to the submitted article.