Group C streptococcal meningitis in infancy

Streptococcus equi subspecies zooepidemicus Meningitis, Septicemia, and Brain Infarcts in a Costa Rican Infant

Streptococcus equi, an equine commensal bacterium, is a rare etiology of septicemia and meningoencephalitis in humans and is extremely infrequent in children. Scarce literature has been published about its clinical presentation, treatment and outcomes in infants. Here, we describe a case of S. equi subsp. zooepidemicus septicemia and meningoencephalitis in a five-month-old Costa Rican infant that was confirmed by peripheral blood and cerebrospinal fluid (CSF) cultures in a regional hospital of the Pacific coast of Costa Rica who developed multiple ischemic cerebral infarcts secondary to infectious vasculitis, a subdural empyema and serious neurological sequelae. We also reviewed the literature on S. equi meningitis in infants under one year of age. This is the first reported case in our country, the fourth reported in infants under one year of age and the second describing multiple cerebral infarcts and subdural empyema in an infant.

Possible canine source of Streptococcus equi subspecies zooepidemicus causing meningitis in an infant

Streptococcus equi subspecies zooepidemicus (S. zooepidemicus) is a pathogen that colonizes and causes disease in horses, and less commonly, in other mammals. This zoonotic disease in humans is rare. In the reported human cases, it has caused bacteremia, endocarditis, arthritis and meningitis, and it has been linked to contact with horses or ingestion of unpasteurized dairy products.

We report a case of a six-month-old female patient who presented with a one-day history of fevers and neurological symptoms. Blood and cerebrospinal fluid cultures revealed S. zooepidemicus, and brain imaging showed a subdural fluid collection and diffuse brain infarcts. Exposure history suggested a canine source as patient had close contact with two dogs that had respiratory infections but no contact with other pets including horses. She had clinical and radiographic improvement after a four-week course of penicillin G and drainage of a subdural fluid collection but she had residual severe to profound hearing loss and mild neurocognitive deficits. This case report provides the third reported case of possible S. zooepidemicus transmission from dogs to humans, and the second such case that has led to meningitis. Clinicians and public health practitioners should recognize that S. zooepidemicus may be transmitted from dogs and can lead to severe disease in humans.

Recurrent Streptococcus equi subsp. zooepidemicus Bacteremia in an Infant

We describe a case of an infant with recurrent bacteremia caused by Streptococcus equi subsp. zooepidemicus, likely transmitted from mother to infant. Our case highlights the importance of an epidemiological history and molecular diagnostics in ascertaining insights into transmission, pathogenesis, and optimal management.