Group A Streptococcus Meningitis in Children

• Published in: The Pediatric infectious disease journal Vol. 32; no. 2; pp. 110 - 114
• Main Authors: de Almeida Torres, Rosângela Stadnick Lauth, Fedalto, Luiz Ernesto, de Almeida Torres, Rômulo Francisco, Steer, Andrew C, Smeesters, Pierre Robert
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins, Inc 01-02-2013; Lippincott Williams & Wilkins
• Subjects: Anti-Bacterial Agents - administration & dosage; Bacterial diseases; Biological and medical sciences; Brazil - epidemiology; Chi-Square Distribution; Child; Child, Preschool; Female; Human bacterial diseases; Humans; Incidence; Infant; Infant, Newborn; Infectious diseases; Male; Medical sciences; Meningitis, Bacterial - drug therapy; Meningitis, Bacterial - epidemiology; Meningitis, Bacterial - microbiology; Microbial Sensitivity Tests; Retrospective Studies; Staphylococcal infections, streptococcal infections, pneumococcal infections; Statistics, Nonparametric; Streptococcal Infections - drug therapy; Streptococcal Infections - epidemiology; Streptococcal Infections - microbiology; Streptococcus pyogenes - drug effects; Streptococcus pyogenes - genetics; Streptococcus pyogenes - isolation & purification; Brazil; Human; Pediatrics; Nervous system diseases; Virulence; Epidemiology; Incidence; Infection; Streptococcaceae; Streptococcal infection; Central nervous system disease; Bacteriosis; virulence determinants; Bacteria; Micrococcales; Meningitis; Streptococcus pyogenes; Child
• ISSN: 0891-3668; 1532-0987
• DOI: 10.1097/INF.0b013e31826fd4af

OBJECTIVE:To characterize the epidemiologic burden and the molecular determinants of group A streptococcal (GAS) meningitis among the pediatric population of the state of Paraná, Brazil.
METHODS:Clinical and epidemiologic data were gathered by a compulsory notification system during the period 2003 to 2011. Bacterial identification, antibiotic resistance profile, emm-typing, pulsed-field gel electrophoresis typing and virulence profile were analyzed by a central reference laboratory. A review of published pediatric cases of GAS meningitis from the last 45 years was undertaken and compared with the Brazilian series.
RESULTS:The incidence of GAS meningitis among the pediatric population was 0.06 cases per 100,000 children per year and was associated with a case fatality rate of 43%. Neonatal age and the presence of an associated toxic shock syndrome were identified as risk factors for death. A distant focus of infection was present in more than half of the patients in the literature and in 36% in the Brazilian case series. A high diversity of emm-types was associated with GAS meningitis in Brazil. No single virulence determinant could be associated with death.
CONCLUSIONS:GAS meningitis is associated with high mortality and with a high diversity of GAS emm-types and virulence determinants in Brazil.