Bacterial meningitis. A rare cause.

Sílvia Bacalhau, Maria Manuel Zarcos, Teresa Rezende


Meningitis is an uncommon clinical manifestation of invasive infection by Streptococcus pyogenes.A four years-old female child, previously healthy, started a history of high fever, associated to right otorrhea, prostration and vomiting. On admission she was haemodynamically stable but prostrated, with stiff neck and right otorrhea. Laboratory evaluation showed leukocytosis with neutrophilia, thrombocytosis and high C-reactive protein. The cerebrospinal fluid (CSF) examination suggested bacterial meningitis and treatment with ceftriaxone was started. After Streptococcus pyogenes grew in the CSF, clindamycin was added. She completed 15 days of antibiotics and was discharged clinically recovered. No neurological or hearing sequelae were observed.Although the incidence of group A streptococcal meningitis seems to be low, invasive infection by this agent is raising. Despite the excellent evolution of this case, a fatal outcome or neurological sequelae can arise, even in healthy children.

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