Cervical pregnancy complicated with group B streptococcal meningitis

Community-acquired group B streptococcal meningitis in adults

INTRODUCTION

Streptococcus agalactiae (group B streptococci; GBS) is an uncommon cause of bacterial meningitis in adults.

METHODS

We reviewed literature published between 1975 and 2018. Studies were included if they reported age, sex and outcome of patients above 16 years of age with cerebrospinal fluid culture (CSF) positive for GBS.

RESULTS

Sixty-seven articles describing 141 patients were included. Median age was 56 years (IQR 41-66); 52% were male. Fifty-three patients (38%) were immunocompromised and CSF leakage was reported in 9 (10%) of 88 immunocompetent patients. Sixty-two patients (44%) had extra-meningeal foci of infection, most commonly endocarditis, which occurred in 14 patients (12%). Twenty-eight patients (23%) were described as previously healthy. Forty-four (31%) of the 141 patients died, after a median duration of 5 days after admission. Death was associated with advanced age and an immunocompromised state.

CONCLUSION

GBS meningitis in adults mainly occurs in those with underlying conditions such as immunocompromised state, CSF leakage, and endocarditis. These conditions should be actively sought for in adults with GBS meningitis.

Streptococcus agalactiae Meningitis in Adult Patient: A Case Report and Literature Review

We report a case of group B streptococcus meningitis in a 72-year-old female patient who was admitted in our hospital with a 21-day history of bilateral lower thigh pain and swelling associated with fever, headache, and vomiting. Her past medical history was remarkable for DM type 2, hypertension, and hypothyroidism. Upon admission, examination showed bilateral warmth and tender soft tissue swelling around the knees and MRI showed cellulitis of distal thirds of both thighs. The next day, the patient became drowsy. Neurologic examination showed neck rigidity and right sided hemiparesis. Cerebrospinal fluid and blood cultures yielded group B streptococcus sensitive to ceftriaxone, penicillin G, and vancomycin. The patient received ceftriaxone for a total of 14 days after which she improved and was discharged from the hospital with right sided weakness.

Diagnostic and therapeutic dilemmas of cervical ectopic pregnancy

IMPORTANCE

Cervical pregnancy is a rare variety of ectopic pregnancy. The etiology is obscure. Its diagnosis may be difficult, and its management has enormously changed during the last 10 years. Unfortunately, the most effective, fertility-sparing treatment is still unclear until now.

OBJECTIVES

The aim of this study was to explore the safety and efficacy of different treatment modalities of cervical pregnancy.

EVIDENCE ACQUISITION

A comprehensive systematic review of the literature was performed using the electronic databases MEDLINE and PubMed, using key words cervical, ectopic, and pregnancy, between January 2005 and June 2013. We included all case reports and case series reporting on cervical ectopic pregnancy.

RESULTS

A total of 252 cases of cervical ectopic pregnancy were analyzed. Eighty-eight cases (34.9%) had medical treatment, 69 cases (27.5%) had surgical treatment, and 95 cases (37.6%) had combined medical and surgical treatment. Various conservative treatment regimens have been introduced to preserve fertility in young women, with methotrexate being one of the most widely used and effective drugs.

CONCLUSIONS AND RELEVANCE

A high index of suspicion, combined with meticulous review of clinical and radiological findings, is essential to make an accurate diagnosis of cervical pregnancy. The success of conservative treatment depends mainly on early diagnosis. Such cases would be best managed at specialist tertiary referral centers and preferably, where available, Early Pregnancy Assessment Units, whether medical, surgical, or combined treatment modalities were attempted.