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Dou ZZ, Li W, Hu HL, Guo X, Hu B, Chen TM, Chen HY, Guo LY, Liu G. Group A Streptococcal meningitis in children: a short case series and systematic review. Eur J Clin Microbiol Infect Dis 2024:10.1007/s10096-024-04863-2. [PMID: 38842766 DOI: 10.1007/s10096-024-04863-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/24/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Group A streptococcal(GAS) meningitis is a severe disease with a high case fatality rate. In the era of increasing GAS meningitis, our understanding about this disease is limited. PURPOSE To gain a better understanding about GAS meningitis. METHODS Five new cases with GAS meningitis were reported. GAS meningitis related literatures were searched for systematic review in PUBMED and EMBASE. Case reports and case series on paediatric cases were included. Information on demographics, risk factors, symptoms, treatments, outcomes, and emm types of GAS was summarized. RESULTS Totally 263 cases were included. Among 100 individuals, 9.9% (8/81) had prior varicella, 11.1% (9/81) had anatomical factors, and 53.2% (42/79) had extracranial infections. Soft tissue infections were common among infants (10/29, 34.5%), while ear/sinus infections were more prevalent in children ≥ 3 years (21/42, 50.0%). The overall case fatality rate (CFR) was 16.2% (12/74). High risk of death was found in patients with shock or systemic complications, young children(< 3 years) and cases related to hematogenic spread. The predominate cause of death was shock(6/8). Among the 163 patients included in case series studies, ear/sinus infections ranged from 21.4 to 62.5%, while STSS/shock ranged from 12.5 to 35.7%, and the CFR ranged from 5.9 to 42.9%. CONCLUSIONS A history of varicella, soft tissue infections, parameningeal infections and CSF leaks are important clinical clues to GAS in children with meningitis. Young children and hematogenic spread related cases need to be closely monitored for shock due to the high risk of death.
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Affiliation(s)
- Zhen-Zhen Dou
- Department of Infectious Diseases, Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Ministry of Education, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
- Research Unit of Critical infection in Children, Chinese Academy of Medical Sciences, Beijing, 2019RU016, China
| | - Wanrong Li
- Department of Infectious Diseases, Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Ministry of Education, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
- Research Unit of Critical infection in Children, Chinese Academy of Medical Sciences, Beijing, 2019RU016, China
| | - Hui-Li Hu
- Department of Infectious Diseases, Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Ministry of Education, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
- Research Unit of Critical infection in Children, Chinese Academy of Medical Sciences, Beijing, 2019RU016, China
| | - Xin Guo
- Department of Infectious Diseases, Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Ministry of Education, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
- Research Unit of Critical infection in Children, Chinese Academy of Medical Sciences, Beijing, 2019RU016, China
| | - Bing Hu
- Department of Infectious Diseases, Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Ministry of Education, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
- Research Unit of Critical infection in Children, Chinese Academy of Medical Sciences, Beijing, 2019RU016, China
| | - Tian-Ming Chen
- Department of Infectious Diseases, Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Ministry of Education, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
- Research Unit of Critical infection in Children, Chinese Academy of Medical Sciences, Beijing, 2019RU016, China
| | - He-Ying Chen
- Department of Infectious Diseases, Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Ministry of Education, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
- Research Unit of Critical infection in Children, Chinese Academy of Medical Sciences, Beijing, 2019RU016, China
| | - Ling-Yun Guo
- Department of Infectious Diseases, Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Ministry of Education, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
- Research Unit of Critical infection in Children, Chinese Academy of Medical Sciences, Beijing, 2019RU016, China
| | - Gang Liu
- Department of Infectious Diseases, Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Ministry of Education, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
- Research Unit of Critical infection in Children, Chinese Academy of Medical Sciences, Beijing, 2019RU016, China.
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Torres L, M Rodrigues A, Francisco C, Santos S, Carvalho P. Streptococcus pyogenes Meningitis in a Pediatric Patient: Case Report. ACTA MEDICA PORT 2024; 37:142-144. [PMID: 37405907 DOI: 10.20344/amp.19941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/23/2023] [Indexed: 07/07/2023]
Abstract
Streptococcus pyogenes causes a wide spectrum of diseases in children. However, meningitis due to this pathogen is highly uncommon. Although rare, it is associated with a high case fatality rate and can result in severe neurological sequelae. We report a case of Streptococcus pyogenes meningitis in a previously healthy 3-year-old boy. The purpose of this case report is to emphasize that this agent should be considered a cause of meningitis in previously healthy infants because of its frequent association with complications, sequelae, and high mortality rates.
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Affiliation(s)
- Lara Torres
- Pediatrics Department. Hospital de Sousa Martins. Unidade Local Saúde da Guarda. Guarda. Portugal
| | - Alexandra M Rodrigues
- Pediatrics Department. Hospital de Sousa Martins. Unidade Local Saúde da Guarda. Guarda. Portugal
| | - Catarina Francisco
- Pediatrics Department. Hospital de Sousa Martins. Unidade Local Saúde da Guarda. Guarda. Portugal
| | - Sónia Santos
- Pediatrics Department. Hospital de Sousa Martins. Unidade Local Saúde da Guarda. Guarda. Portugal
| | - Pedro Carvalho
- Pediatrics Department. Hospital de Sousa Martins. Unidade Local Saúde da Guarda. Guarda. Portugal
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Kanzaki G, Tsuboi N, Yokoo T, Uesugi N, Furuichi K, Shimizu A, Sugiyama H, Sato H, Yokoyama H. Seasonal variations in renal biopsy numbers and primary glomerular disease features based on the Japan renal biopsy registry. Sci Rep 2023; 13:5123. [PMID: 36991090 PMCID: PMC10060207 DOI: 10.1038/s41598-023-32182-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 03/23/2023] [Indexed: 03/31/2023] Open
Abstract
We analyzed the seasonal variations in the number of renal biopsies and clinical characteristics of primary glomerular disease in Japan using the Japan Renal Biopsy Registry (J-RBR). We retrospectively collected clinical and pathological data of patients with primary glomerular disease who were registered in the J-RBR between 2007 and 2018. Immunoglobulin A nephropathy (IgAN), minimal change nephrotic syndrome (MCNS), membranous nephropathy (MN), and postinfectious acute glomerulonephritis (PIAGN) constituted the four major glomerular disorders included in this study (total, 13,989; IgAN, 9121; MCNS, 2298; MN, 2447; and PIAGN, 123). The number of patients with IgAN or MCNS was higher during summer. However, no overt seasonal variations were observed in patients with MN or PIAGN. Subgroup analyses suggested that in the patients with IgAN, more renal biopsies of severe cases were performed during winter, probably owing to age and blood pressure. Furthermore, more renal biopsies of severe cases were performed during spring and winter in patients with MCNS even after adjusting for the abovementioned host factors. This study suggests that seasonal factors influence the decision to perform renal biopsy as well as the pathogenesis of primary glomerular disease. Thus, our findings may provide important insights regarding the pathophysiology of primary glomerular disease.
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Affiliation(s)
- Go Kanzaki
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Minato-ku, Tokyo, 105-8461, Japan.
| | - Nobuo Tsuboi
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Minato-ku, Tokyo, 105-8461, Japan
| | - Takashi Yokoo
- Division of Nephrology and Hypertension, Department of Internal Medicine, The Jikei University School of Medicine, Minato-ku, Tokyo, 105-8461, Japan
| | - Noriko Uesugi
- Department of Pathology, Fukuoka University, Fukuoka, Japan
| | - Kengo Furuichi
- Division of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
| | - Akira Shimizu
- Department of Analytic Human Pathology, Nippon Medical School, Tokyo, Japan
| | - Hitoshi Sugiyama
- Department of Human Resource Development of Dialysis Therapy for Kidney Disease, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroshi Sato
- Department of Internal Medicine, Sendai Hospital of East Japan Railway Company, Sendai, Japan
| | - Hitoshi Yokoyama
- Division of Nephrology, Kanazawa Medical University School of Medicine, Ishikawa, Japan
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Lee J, Blackburn J, Pham-Huy A. Uncommon clinical presentation of a common bug: Group A Streptococcus meningitis. Paediatr Child Health 2020; 26:e129-e131. [PMID: 33936341 DOI: 10.1093/pch/pxaa065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 04/08/2020] [Indexed: 11/12/2022] Open
Abstract
Group A Streptococcus (GAS) is a common pathogen in paediatric infections. However, it is a rare etiologic agent of bacterial meningitis. We describe a case of Streptococcus pyogenes meningitis complicated by sensorineural hearing loss in an immunocompetent 7-year-old boy. Clinicians should be aware of GAS as a potential cause of paediatric meningitis, especially with prominent symptoms suggestive of frontal sinusitis. Meningitis caused by GAS has been shown to be associated with significant mortality and morbidity, including neurological complications. Early screening for sensorineural hearing loss in patients with GAS meningitis can facilitate timely cochlear implant.
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Affiliation(s)
- Jimin Lee
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario
| | - Julie Blackburn
- Division of Infectious Diseases, Immunology and Allergy, Department of Pediatrics, University of Ottawa, Ottawa, Ontario
| | - Anne Pham-Huy
- Division of Infectious Diseases, Immunology and Allergy, Department of Pediatrics, University of Ottawa, Ottawa, Ontario
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Acute Mastoiditis Associated with Pseudomonas Aeruginosa in the Pediatric Population of the Umbria Region, Italy. Pathogens 2019; 8:pathogens8040180. [PMID: 31600897 PMCID: PMC6963525 DOI: 10.3390/pathogens8040180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/30/2019] [Accepted: 10/08/2019] [Indexed: 11/17/2022] Open
Abstract
Acute mastoiditis (AM) is the most common complication of acute otitis media (AOM) and is one of the most severe acute bacterial diseases in infants and children. In some geographic areas, the incidence of AM is increasing, and the causative role of some bacterial pathogens could be greater than previously thought. In this paper, the results of a study that evaluated the epidemiology and microbial etiology of paediatric AM in Umbria, which is a region of central Italy, are reported. This is a retrospective study of patients aged 0-14 years with AM admitted to the pediatric wards of the hospitals of Umbria, Italy, between June 1 and September 30 in four consecutive years (2015-2018). A total of 108 children were enrolled. The prevalence of AM in males during the four years of analysis was significantly higher than that in females at 63% (95% confidence intervals [CI]: 0.54-0.72). The most frequently affected age groups were 5-9 years (45.4%) and 10-14 years (31.5%), with statistically significant differences in comparison with children aged <1 year (5.6%, 95% CI: 0.01-0.10) and 1-4 years (17.6%, 95% CI: 0.10-0.25). In most cases (64, 59.3%), AM was associated with spontaneous tympanic membrane perforation (STP). The culture of the middle ear fluid revealed the presence of Pseudomonas aeruginosa in 56 cases (51.6%). The mean incidence rates of pediatric AM in Umbria during the study increased significantly with time, as it was 18.18/100,000 children/year in 2015-2016 and 29.24/100,000 children/year in 2017-2018 (CI difference: +2.5 - +19.9, p < 0.05). The incidence rates of Pseudomonas aeruginosa detection in pediatric AM associated with STP significantly increased with time. The incidence was 6.06/100,000 children/year in 2015-2016 and 18.61/100,000 children/year in 2017-2018 (CI difference: +6.1 - +19.0, p < 0.001). This study demonstrated the high and increasing incidence of AM in the Umbria region during the summer months and the frequent detection of P. aeruginosa as an etiologic agent of the disease in the presence of STP. Confirmation of these results with a larger study population, in different settings, and throughout the whole year is needed to define the first-line approach of AM with STP in pediatrics.
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