Delayed diagnosis of meningitis caused by beta-haemolytic group G. Streptococcus in an older woman

Diagnosis of Neurological Involvement Caused by Streptococcus dysgalactiae: A Case Report and Review of the Literature

Purpose

This study investigated the clinical relevance, pathogenic mechanisms, and neurological involvement of Streptococcus dysgalactiae subspecies equisimilis (SDSE) and subspecies dysgalactiae (SDSD), with a focus on a severe case of SDSE meningitis complicated by septic shock.

Patients and Methods

A systematic review of 19 cases of neurological infections caused by S. dysgalactiae (SDSE or SDSD) from 1971 to 2023 was conducted, supplemented by a detailed case report. Data on patient demographics, predisposing factors, clinical manifestations, diagnostic procedures, treatment, and outcomes were analyzed.

Results

The reviewed cases involved 12 patients with SDSE and seven with SDSD. The median age was 53 years, and most patients had underlying conditions such as diabetes, malignancy, or cardiovascular disease. Neurological manifestations were common, with meningitis being diagnosed in 17 patients. Despite prompt antibiotic therapy, six patients (32%) died, highlighting the severe nature of these infections.

Conclusion

S. dysgalactiae can cause severe neurological infections, particularly in immunocompromised patients. Early recognition and aggressive treatment are essential to improving outcomes. Advanced molecular diagnostic techniques, such as next-generation sequencing (NGS), are crucial in identifying and managing these infections.

Acute Bacterial Meningitis and Systemic Abscesses due to Streptococcus dysgalactiae subsp. equisimilis Infection

Disseminated abscesses due to group G β-hemolytic Streptococcus dysgalactiae were observed in a 57-year-old cirrhotic patient with the skin being the putative way of entry for the pathogen. S. dysgalactiae is a rare agent in human infections responsible for acute pyogenic meningitis. The mortality rate associated with S. dysgalactiae bacteraemia and meningitis may be as high as 50%, particularly in the presence of endocarditis or brain abscesses. In our patient, main sites of infections were meningitis and ventriculitis, spondylodiscitis, septic arthritis, and soft-tissue infections. In contrast, no endocarditis was evidenced. Cirrhosis-related immune suppression was considered as a pathophysiological cofactor for the condition. Fortunately, clinical status improved after long-term (3 months) antimicrobial therapy.