Group A Streptococcal Meningitis in Children
2013; Lippincott Williams & Wilkins; Volume: 32; Issue: 9 Linguagem: Inglês
10.1097/inf.0b013e3182998f9a
ISSN1532-0987
AutoresCorinne Lévy, Philippe Bidet, Stéphane Bonacorsi, Robert Cohen,
Tópico(s)Pneumonia and Respiratory Infections
ResumoTo the Editors: We read with interest the recent article "Group A streptococcus meningitis in children," by de Almeida Torres et al,1 published in the February issue of The Pediatric Infectious Disease Journal. The authors reported 14 cases of group A streptococcal (GAS) meningitis in children in the state of Paraná, southern Brazil, from 2003 to 2011 and compared these cases with those in the literature (57 cases from 1966 to 2011).1–3 In 2001, the French Pediatric Infectious Diseases Group established an active surveillance network4 to analyze the epidemiologic, clinical and biologic features of bacterial meningitis in children in France; among 4564 cases reported from 2001 to 2012, 34 (0.7%) were GAS meningitis. Some clinical and biologic features of our series of GAS meningitis are similar to those reported for Brazil, but others are quite different. First, in our series, the median age was higher, 5.6 years (minimum to maximum, 1.3 months to 14.2 years), than that for Brazil and in the literature, 2.4 and 0.9 years, respectively.1–3 Second, in our series, the sex ratio (M/F, 1.8) was the reverse of that for Brazil. Third, in our series, the ratio of children with extrameningeal primary focus of infection, nearly 60% of children (41% with acute otitis media and 18% with tonsillopharyngitis), was higher than that for Brazil (36%) but comparable with the 62% found in the literature.1 Finally, the most striking difference between the Brazil series and our series is the case fatality rate, 43% versus 6%, respectively. In our series, only 2 patients died. The first patient, a 9-month-old boy, had no risk factors. He presented with fulminant septicemia and died 6 hours after hospital admission, despite appropriate supportive care and prompt antibiotic treatment. The second patient, an 8-year-old boy, had had recurrent meningitis. However, several clinical and biologic features are similar between the 2 series. We found a low rate of underlying conditions (17.6% versus 7.1%, P = 0.3). de Almeida Torres et al observed a broad diversity of emm types among GAS isolates recovered from patients with meningitis (9 emm types in 14 isolates). Among the 12 stains with available serotyping in our study, the emm types were emm1 (n = 4), emm6 (n = 3) and 1 case each of emm3, emm12, emm28, emm44 and emm102. Data from cerebrospinal fluid analysis were similar: median leukocyte count (1000 cells/mm3), neutrophil proportion (79%) and protein and glucose values (1.2 g/L and 2.6 mmol/L, respectively). Comparing the 2 series in terms of microbiologic diagnosis would have been of interest. We found CSF positivity on Gram staining and culture in 57% and 85% of cases, respectively, and when CSF culture findings were negative, microbiologic diagnosis was based on positive blood culture and pleiocytosis (12%) and positive CSF PCR results (3%). We have compared clinical and biologic data for GAS meningitis and meningitis caused by other pathogens (data not shown) and found the data indistinguishable. The reason for the high mortality rate (43%) observed in the Brazil series when compared with the literature and with our series is not clear but could be because of differences in socioeconomic conditions, immunogenetics, health-care systems and access to medical care. In conclusion, we point to the wide differences in epidemiologic, clinical and outcome profiles of GAS meningitis between the 2 countries. ACKNOWLEDGMENTS We are grateful the following pediatricians and microbiologists: S. Aberrane, E. Audry, D. Berterottière, J.C. Berthier, M. Bingen, J.F. Blanc, P. Boquet, C. Bosi, G. Bovero, M. Boyer, P. Bruyas, Buisson-Touati, F. Canis, M. Carre, C. Carriere, C. Cattoen, Y. Chaix, Chalvon Demersay, G. Descours, R. Dessein, A. Chantepie, F. Chaumienne, E. Cheuret, Cointin, A. Collignon, A. Constanty, Cosson, Y. Costa, R. Courcol, I. Craiu, C. Danan, F. Denis, Dhaoui, D. De Ricaud, D. Devictor, F. Dubos, B. Dumoulard, A. Elbez-Rubinstein, D. Fasquelle, Fevre, U. Frey, Garbarg-Chenon, F. Garnier, A. Gaschet, J. Gaudelus, Gauduchon, Y. Gillet, A. Girier, F. Girard, A. Goudeau, G. Guyon, H. Haas, F. Hallalel, Hasselmann, L. Hees, M.B. Hevin Martin, N. Hidri, Jaouen, P. Jeannoel, P. Lanotte, D. Landragin, L. Lazzaro, C. Lebrun, F. Leclerc, Lefrand-Crepin, P. Lehours, A. Lienhardt, S. Louf, R. Martin, A. Martinot, M. Menouar, P. Monin, P. Nordmann, O. Oules, I. Poilane, Porcheret Huong, I. Py, E. Questiaux, S. Renolleau, D. Rivaux, M. Rodiere, D. Rosellini, A. Sadik, Sadki, Said-Menthon, J. Sarlangue, A. Sfez, Spicq, C. Tiry, A. Trstan, Vanel Contamin, P. Van de Perre, F. Vandenesch, L. Villeneuve, Vu-Thien, M. Weber. We thank Pr Edouard Bingen, in memoriam. Corinne Levy, MD ACTIV (Association Clinique et Thérapeutique Infantile du Val de Marne) GPIP, Groupe de Pathologie Infectieuse Pédiatrique de la SFP (Société Française de Pédiatrie) CRC, Centre Hospitalier Intercommunal de Créteil Paris, France Philippe Bidet, MD, PhD Stéphane Bonacorsi, MD Service de Microbiologie, Hôpital Robert- Debré (AP-HP) Université Denis-Diderot Paris, France Bacterial Meningitis Study Group GPIP, Groupe de Pathologie Infectieuse Pédiatrique de la SFP (Société Française de Pédiatrie) Paris, France Robert Cohen, MD ACTIV (Association Clinique et Thérapeutique Infantile du Val de Marne) GPIP, Groupe de Pathologie Infectieuse Pédiatrique de la SFP (Société Française de Pédiatrie) CRC, Centre Hospitalier Intercommunal de Créteil Paris, France
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