Streptococcos Pyogenes Meningitis in an Imunnocompetent Child

Background: Group A streptococci (GAS) infections of the central nervous system are extremely rare in the antibiotic era, accounting for less than 1% of all childhood meningitis. However, in the last decades, recent reports suggest an increase in invasive SGA infections.

Case Presentation Summary: The authors present a case of a 3-year-old boy admitted to the emergency room, with a history of high fever, cough, vomiting and lethargy. He had been diagnosed with varicella 5 days before and medicated with acyclovir.

On examination, he presented paleness, positive Kernig`s and Brudzinski`s sign, and nuchal rigidity. He also had several crusted lesions spread across the whole body and some petechiae. Vital signs were normal.

Laboratory tests results showed a white blood cell count of 17.1×10^9/L (82% neutrophils, 11.4% lymphocytes and 6% monocytes) and a C-reactive protein of 212 mg/l. Lumbar puncture revealed a nucleated cell count of 27cel/mm³, a protein of 36.9mg/dL and a glucose of 80mg/dL.

Therapy with intravenous (IV) ceftriaxone and acyclovir was started. Twenty-four hours later, GAS was isolated in the cerebrospinal fluid (CSF). Antibiotics were switched to IV penicillin G and clindamycin.

The patient was discharged after 16 days. He was asymptomatic, with no sequelae.

Learning Points/Discussion: In paediatric patients, varicella is a well-documented risk factor for invasive GAS, associated with approximately 15% to 30% of such infections.

Post-varicella GAS meningitis has rarely been reported and it seems to be related to skin lesions. However the pathogenesis of GAS meningitis has not been entirely explained.