Journal of Postgraduate Medicine
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Year : 1989  |  Volume : 35  |  Issue : 1  |  Page : 49-50  

Fatal outcome of group-G streptococcal meningitis (a case report).

PK Mohan, JJ Shanmugam, AA Nair, JJ Tharakan 
 

Correspondence Address:
P K Mohan


Abstract

An adult woman developed meningitis caused by Group-G streptococci. The organism was successfully isolated both from blood and cerebrospinal fluid of the patient. The woman succumbed to infection despite an appropriate antibiotic therapy.



How to cite this article:
Mohan P K, Shanmugam J J, Nair A A, Tharakan J J. Fatal outcome of group-G streptococcal meningitis (a case report). J Postgrad Med 1989;35:49-50


How to cite this URL:
Mohan P K, Shanmugam J J, Nair A A, Tharakan J J. Fatal outcome of group-G streptococcal meningitis (a case report). J Postgrad Med [serial online] 1989 [cited 2022 Oct 1 ];35:49-50
Available from: https://www.jpgmonline.com/text.asp?1989/35/1/49/5725


Full Text



 INTRODUCTION



Since the original isolation and identification of Group-G streptococci in 1935 by Lancefield and Hare,[8] the organism has been implicated as one among the normal bacterial flora of the skin, pharynx, gastrointestinal and female genital tracts.[4],[6] However, serious infections with this organism are being reported with an increasing frequency, as has been reflected in recent literatures.[2],[7],[11],[12]

Although introduction of various rapid identification techniques may account for a portion of these cases, there are enough reports to emphasise the fact that Group-G streptococci established as the oppertunistic pathogens for the last one decade. Here we report a fatal case of meningitis in an elderly woman complicating Group-G streptococcal bacteremia, despite appropriate antibiotic therapy.

 CASE REPORT



A sixty six year old house wife was admitted in our hospital (SCTIMST) in July, 1984 with a history of fever for one week, progressive deterioration of sensorium for three days and an acute onset of left hemiplegia for one day. On examination she was found febrile and on neurological examination she was deeply comatosed with 0/5 left hemiplegia and signs of meningeal irritation. Optic fundi were normal Cerebro Spinal fluid examination showed 60 lymphocytes/Cu.mm with 125 mg% protein and 111 mg% of sugar. There was polymorphonuclear leucocytosis and very high erythrocyte sedimentation rate of 98 mm/1st hour. Beta haemolytic streptococci were isolated both from the systemic blood and cerebrospinal fluid. The bacterial isolates were identified as Group-G streptococci by means of sero-grouping by agar gel diffusion technique using formamide extracts of the strain and group-specific antisera obtained from the Director of W.H.O. Streptococcal Regional Reference and Research Centre, Prague, Czechoslovakia. The streptococci were found to be sensitive to cephalosporin, chloramphenicol, erythromycin, gentamycin, penicillin, streptomycin and tetracycline, as tested by agar diffusion technique. The patient was treated with crystalline penicillin and gentamycin sulphate. Though she showed clinical improvement for the first two days, her neurological :condition deteriorated and after two days she succumbed to infection.

 DISCUSSION



Serious focal infections complicating Group-G streptococcal bacteremia is relatively an uncommon entity. Several reviews on group-G streptococcal infections have stressed the potential of this organism a the etiological agent of endocarditis and septic arthritis.[3],[7],[9],[10] Meningitis due t group-G beta haemolytic streptococci has however rarely been reported[1],[5] and to our knowledge there is no such report from the Indian sub-continent

The interesting feature observed in this patient was the disparity between in vitro antibiotic sensitivity and in vivo clinical response to appropriate antibiotic therapy by gentamycin and penicillin-G. Although similar clinico-bacteriological failure of penicillin-G therapy despite 'sensitive' group-G streptococcal isolates have been reported in literature, the reason for such phenomenon is not yet understood.[3],[7],[9],[10] Lam and Bayer[7] in their detailed killing; curve studies have demonstrated a poor killing of huge number of stationary phase organisms in vitro. They have compared this in-vitro condition to in-vivo setting of infective endocarditis to partially explain the disappointing clinical outcome among their case studies. However, there are other reports indicating satisfactory responses to antimicrobial therapy in patients with group-G streptococcal infections.[7],[11],[12] The present case of a woman patient with/group-G streptococcal infection with a therapeutic failure and fatal outcome high light the importance of this erstwhile non-pathogen emerging as an important opportunistic human pathogenic bacteria. Hence nowadays one has to be very cautious not to undermine the importance of group-6 streptococcal isolates from clinical specimens.

References

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3Bouza, E., Meyer, R. D. and Busch, D. F.: Group G streptococcal endocarditis. Amer. J. Clin. Pathol., 70: 108-111, 1978.
4Cudney, N. 7. C. and Albers, A. C.: Group G streptococci: a review of the literature. Amer. J. Med. Technol., 48: 37-42, 1982.
5Duma, R. J., Weinberg, A. N., Medrek T. F. and Kunz, L. J.: Streptococcal infections: A bacteriological and clinical study- of Streptococcal bacteremia, Medicine, 48: 87-127, 1969.
6Hill, H. R., Caldwell, G. G., Wilson, E., I-lager, D. and Zimmerman, R. A.: Epidemic of pharyngitis due to Streptococci of Lancefield Group G. Lancet, 2: 371-374, 1969.
7Lam, K. and Bayer, A. S.: Serious infections due to Group G Streptococci, Report of 15 cases with invitro-invivo correlations. liner. J. Med., 75: 561-570, 1983.
8Lancefield, R. C. and Hare, R.: The serological differentiation of pathogenic and nor.-pathogenic strains of haemolytic Streptococci from parturient women. J Exp. Med,. 61: 335-33-49, 1935.
9Lin, A. N., Karasik, A., Salit, I. E. and Fam, A. G.: Group G streptococcal arthritis. J. Rheumatol., 9: 424-427, 1982.
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11Vartian, C., Lerner, P. I., Shlaes, D. M and Gopalkrishnan, K. V.: Infections due to Lancefield group G streptococci. Medicine, 64: 75-88, 1985.
12Watsky, K. L., Kollisch, N. and Densen P.: Group G Streptococci bacteremia. The clinical experience at Boston University Medical Center and a critical review of the literature. Arch. Intern. Med., 145. 58.61, 1985.

 
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