Abstract
A case is described of a 79-year-old man, trampled by his horses, who subsequently developed a wound infection and, later, meningitis. Streptococcus equi subsp. zooepidemicus was isolated as the causative organism. S. equi subsp. zooepidemicus, which carries the Lancefield Group C antigen, is an uncommon human pathogen but is commonly isolated from bacterial infections in animals, particularly horses. It is most commonly acquired by humans following animal contact. A review of the literature identified 20 previously described cases of S. equi subsp. zooepidemicus meningitis. Crude mortality following infection was 24%. All of the patients who died were over 70 years of age and the ingestion of unpasteurised dairy products was associated with all but one of the fatal cases. Hearing loss was a frequent complication, occurring in 19% of cases. Only 38% of patients made a complete recovery. Treatment regimes commonly included benzylpenicillin or a third-generation cephalosporin, with a mean treatment duration in survivors of 23 days.
Similar content being viewed by others
References
Timoney JF (2004) The pathogenic equine streptococci. Vet Res 35(4):397–409
Holden MT, Heather Z, Paillot R, Steward KF, Webb K, Ainslie F, Jourdan T, Bason NC, Holroyd NE, Mungall K, Quail MA, Sanders M, Simmonds M, Willey D, Brooks K, Aanensen DM, Spratt BG, Jolley KA, Maiden MC, Kehoe M, Chanter N, Bentley SD, Robinson C, Maskell DJ, Parkhill J, Waller AS (2009) Genomic evidence for the evolution of Streptococcus equi: host restriction, increased virulence, and genetic exchange with human pathogens. PLoS Pathog 5(3):e1000346. Epub 2009 Mar 27
Berenguer J, Sampedro I, Cercenado E, Baraia J, Rodríguez-Créixems M, Bouza E (1992) Group-C beta-hemolytic streptococcal bacteremia. Diagn Microbiol Infect Dis 15(2):151–5
Barnham M, Kerby J, Chandler RS, Millar MR (1989) Group C streptococci in human infection: a study of 308 isolates with clinical correlations. Epidemiol Infect 102(3):379–390
Mohr DN, Feist DJ, Washington JA, Hermans PE (1978) Meningitis due to group C streptococci in an adult. Mayo Clin Proc 53(8):529–532
Ghoneim AT, Cooke EM (1980) Serious infection caused by group C streptococci. J Clin Pathol 33(2):188–190
Low DE, Young MR, Harding GK (1980) Group C streptococcal meningitis in an adult. Probable acquistion from a horse. Arch Intern Med 140(7):977–8
Edwards AT, Roulson M, Ironside MJ (1988) A milk-borne outbreak of serious infection due to Streptococcus zooepidemicus (Lancefield Group C). Epidemiol Infect 101(1):43–51
Cheeseman M, Genain C, Smith CD (1990) Group C streptococcal meningitis with favorable recovery. A case report. J Ky Med Assoc 88(10):545–6
Patey O, Buisson CB, Soussy CJ (1990) Group C streptococcal meningitis in adults. Rev Infect Dis 12(1):157–158
Latorre M, Alvarez M, Fernández JM, Berdonces P, Llanos A, Cisterna R (1993) A case of meningitis due to “Streptococcus zooepidemicus”. Clin Infect Dis 17(5):932–933
Mattei P, Beguinot I, Malet T, Evon P, Lion C, Hoen B (1995) Meningitis, septicemia and endophthalmitis caused by Streptococcus equi subspecies zooepidemicus. Presse Med 24(23):1089
Ferrandière M, Cattier B, Dequin PF, Hazouard E, Legras A, Perrotin D (1998) Septicemia and meningitis due to Streptococcus zooepidemicus. Eur J Clin Microbiol Infect Dis 17(4):290–291
Shah SS, Matthews RP, Cohen C (2001) Group C streptococcal meningitis: case report and review of the literature. Pediatr Infect Dis J 20(4):445–448
Downar J, Willey BM, Sutherland JW, Mathew K, Low DE (2001) Streptococcal meningitis resulting from contact with an infected horse. J Clin Microbiol 39(6):2358–2359
Ural O, Tuncer I, Dikici N, Aridogan B (2003) Streptococcus zooepidemicus meningitis and bacteraemia. Scand J Infect Dis 35(3):206–207
Lee AS, Dyer JR (2004) Severe Streptococcus zooepidemicus infection in a gardener. Med J Aust 180(7):366
Bordes-Benítez A, Sánchez-Oñoro M, Suárez-Bordón P, García-Rojas AJ, Saéz-Nieto JA, González-García A, Alamo-Antúnez I, Sánchez-Maroto A, Bolaños-Rivero M (2006) Outbreak of Streptococcus equi subsp. zooepidemicus infections on the island of Gran Canaria associated with the consumption of inadequately pasteurized cheese. Eur J Clin Microbiol Infect Dis 25(4):242–6
Pati S, Al-Araji A, Orendi J (2007) Atypical presentation of Streptococcus zooepidemicus bacteraemia and secondary meningitis. Clin Neurol Neurosurg 109(5):475–6, Epub 2007 Mar 2
Rivas MT, Pascual J, Sesar A (2008) Group C streptococcus meningitis: a very uncommon condition. Neurologia 23(9):604–606
Jovanović M, Stevanović G, Tosić T, Stosović B, Zervos MJ (2008) Streptococcus equi subsp. zooepidemicus meningitis. J Med Microbiol 57(Pt 3):373–375
Bradley SF, Gordon JJ, Baumgartner DD, Marasco WA, Kauffman CA (1991) Group C streptococcal bacteremia: analysis of 88 cases. Rev Infect Dis 13(2):270–80
Declarations
The patient described herein has given his full consent for inclusion in this review.
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Eyre, D.W., S. Kenkre, J., Bowler, I.C.J.W. et al. Streptococcus equi subspecies zooepidemicus meningitis—a case report and review of the literature. Eur J Clin Microbiol Infect Dis 29, 1459–1463 (2010). https://doi.org/10.1007/s10096-010-1037-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10096-010-1037-5