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

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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.

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Acknowledgements

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).

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Authors and Affiliations

  1. Department of Infectious Disease, Aalborg University Hospital, Mølleparkvej 4, DK-9000, Aalborg, Denmark

    Nicolai Kjærgaard, Jacob Bodilsen & Henrik Nielsen

  2. Department of Clinical Microbiology, Odense University Hospital, J. B. Winsløws Vej 4, DK-5000, Odense, Denmark

    Ulrik Stenz Justesen

  3. Department of Clinical Microbiology, Aalborg University Hospital, Hobrovej 18-22, DK-9000, Aalborg, Denmark

    Henrik Carl Schønheyder

  4. Department of Clinical Microbiology, Hvidovre Hospital, Kettegård Alle 30, DK-2650, Hvidovre, Denmark

    Christian Østergaard Andersen

  5. Department of Clinical Microbiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark

    Svend Ellermann-Eriksen

  6. Department of Clinical Microbiology, Sydvestjysk Sygehus, Finsensgade 35, DK-6700, Esbjerg, Denmark

    Esad Dzajic

  7. Department of Clinical Microbiology, Hospital of Southern Jutland, Sydvang 1, DK-6400, Sonderborg, Denmark

    Ming Chen

  8. Department of Clinical Microbiology, Sygehus Lillebælt, Kabbeltoft 25, DK-7100, Vejle, Denmark

    Jens Kjølseth Møller

  9. Department of Clinical Microbiology, Slagelse Hospital, Ingemannsvej 30, DK-4200, Slagelse, Denmark

    Ram Benny Dessau

  10. Department of Clinical Microbiology, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark

    Niels Frimodt-Møller

  11. Department of Clinical Microbiology, Herlev Hospital, Herlev Ringvej 75, DK-2730, Herlev, Denmark

    Jens Otto Jarløv

  12. Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, DK-9000, Aalborg, Denmark

    Henrik Nielsen

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  1. Nicolai Kjærgaard
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  2. Jacob Bodilsen
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  4. Henrik Carl Schønheyder
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  8. Ming Chen
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  9. Jens Kjølseth Møller
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  13. Henrik Nielsen
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the DASGIB Study Group

Corresponding author

Correspondence to Nicolai Kjærgaard.

Ethics declarations

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.

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The authors declare that they have no conflict of interest.

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Kjærgaard, N., Bodilsen, J., Justesen, U.S. et al. Community-acquired meningitis caused by beta-haemolytic streptococci in adults: a nationwide population-based cohort study. Eur J Clin Microbiol Infect Dis 38, 2305–2310 (2019). https://doi.org/10.1007/s10096-019-03678-w

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  • DOI: https://doi.org/10.1007/s10096-019-03678-w

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