Case Report: One Human Streptococcus Suis Infection in Shandong Province, China

Background: Streptococcus suis (S. suis) is an emerging zoonotic pathogen. Case presentation: A 56-year-old woman was infected with S. suis. The patient reared pigs in her backyard. At admission, her blood examinations showed a leukocyte count of 27.28×109/L with 94.20% neutrophils. Cerebrospinal fluid was noted to be cloudy with a leukocyte count of 2700×106/L. Cerebrospinal fluid culture grew gram-positive cocci that were identified as S. suis type II. Ceftriaxone was administered. Conclusion: Human infections with S. suis highlights the need for health education, prevention and surveillance it.

Three-year mortality in cryptococcal meningitis: Hyperglycemia predict unfavorable outcome

Existing evidence revealed grave prognosis for cryptococcal meningitis (CM), particularly its short-term mortality. However, its long-term survival and prognostic factors remained unknown. This study investigated 3-year mortality and analyzed its predictive factors in patients with CM. This retrospective cohort study with 83 cerebrospinal fluid culture-confirmed CM patients was conducted at China Medical University Hospital from 2003 to 2016. The 3-year mortality rate in patients with CM was 54% (45 deaths among 83 patients). Advanced age, human immunodeficiency virus (HIV) seronegative state, low Glasgow Coma Scale score on admission, decreased hemoglobin and hyperglycemia on diagnosis were associated with 3-year mortality. After multivariate adjustment in the Cox proportional hazard model, only severe hyperglycemia (serum glucose ≥200 mg/dL) on diagnosis could predict 3-year mortality.

Unexpectedly High False-Positive Rates for Haemophilus influenzae Using a Meningoencephalitis Syndromic PCR Panel in Two Tertiary Centers

False-positive results in the diagnostic of meningitis and encephalitis pose important challenges. This study aimed to determine false-positive rates for Haemophilus influenzae in cerebrospinal fluids evaluated by the BioFire FilmArray® Meningitis/Encephalitis Panel. We conducted a retrospective study of all H. influenzae-positive FilmArray®. Meningitis/Encephalitis Panel results from June 2016 to October 2019 in two Swiss university hospitals. Cases were classified as true positive, likely true-positive, and likely false-positive results according to cerebrospinal fluid culture, H. influenzae-specific quantitative real-time PCR (qPCR), and Gram staining, as well as culture of other materials. We performed 3,082 panels corresponding to 2,895 patients: 0.6% of the samples (18/3,082) were positive for H. influenzae. Culture and H. influenzae-specific qPCR were performed on 17/18 (94.4%) and 3/18 (16.7%) cerebrospinal fluid samples, respectively; qPCR was negative in all cases. Among 17 samples sent for culture, 10 concerned patients were not treated with antibiotics prior to lumbar puncture. Only 1/17 revealed growth of H. influenzae and was classified as a true positive. We further classified 3/18 (16.7%) cases with the identification of Gram-negative rods in the cerebrospinal fluid or positive blood cultures for H. influenzae as likely true-positive and 14/18 (77.8%) cases as likely false-positive. Diagnostic results should always be interpreted together with the clinical presentation, cerebrospinal fluid analysis, and other available microbiological results. All H. influenzae-positive results should be viewed with special caution and a H. influenzae-specific qPCR should be systematically considered.

Neonatal Escherichia coli Meningitis, Complications, and Neurological Outcome

Neonatal bacterial meningitis represents a major cause of mortality and morbidity in newborns worldwide. It leads to immediate and long-term neurological complications. We report a case of a term newborn with an unremarkable pregnancy and delivery, who was admitted to our neonatal ward on the fifth day of life for fever. Cerebrospinal fluid culture was positive for Escherichia coli. The infant had neurological deterioration and continued fever despite adequate antibiotic therapy. Brain MRI showed multiple subdural abscesses with ventriculitis. Antibiotic therapy was maintained for 90 days with total resolution of the abscesses. The child has a normal physical examination and appropriate psychomotor development at 9 months of age.

Analysis of 11 Cases of Neonatal Invasive Streptococcus pyogenes Infection

Objective This study aimed to improve the understanding of clinical characteristics of neonatal invasive Streptococcus pyogenes infection (iSPI). Methods A retrospective study was performed to analyze the clinical and laboratory aspects of culture-confirmed neonatal iSPI cases during 2010 to 2017. Results Eleven cases of neonatal iSPI were confirmed. The ages ranged from 2 hours to 26 days. Ten cases had positive blood culture results and one had positive cerebrospinal fluid culture for S. pyogenes. Seven patients had fever and seven had identified focal infection, including six skin and soft tissue infections and one case of pneumonia. All of the S. pyogenes strains were sensitive to penicillin, cefotaxime, and vancomycin, and nine were resistant to clindamycin and erythromycin. Six patients received penicillin or cephalosporin monotherapy. Three patients received meropenem plus vancomycin initially, and then two of them were switched to penicillin and one to vancomycin after pathogen identification. Two cases were treated with vancomycin monotherapy. All cases were discharged after being cured or showing improvement. Conclusion Skin and soft tissue infection is a common manifestation of neonatal iSPI. Streptococcus pyogenes strains are highly sensitive to β-lactams, which should be used as the first-choice treatment.

Comparison of the management recommendations of the Kaiser Permanente neonatal early-onset sepsis risk calculator (SRC) with NICE guideline CG149 in infants ≥34 weeks’ gestation who developed early-onset sepsis

ObjectiveTo compare the management recommendations of the Kaiser Permanente neonatal early-onset sepsis risk calculator (SRC) with National Institute for Health and Care Excellence (NICE) guideline CG149 in infants ≥34 weeks’ gestation who developed early-onset sepsis (EOS).DesignRetrospective multicentre study.SettingFive maternity services in South West of England and Wales.Patients70 infants with EOS (<72 hours) confirmed on blood or cerebrospinal fluid culture.MethodsRetrospective virtual application of NICE and SRC through review of maternal and neonatal notes.Main outcome measureThe number of infants recommended antibiotics by 4 hours of birth.ResultsThe incidence of EOS ≥34 weeks was 0.5/1000 live births. Within 4 hours of birth, antibiotics were recommended for 39 infants (55.7%) with NICE, compared with 27 (38.6%) with SRC. The 12 infants advised early treatment by NICE but not SRC remained well, only one showing transient mild symptoms after 4 hours. Another four babies received antibiotics by 4 hours outside NICE and SRC guidance. The remaining 27 infants (38.6%) received antibiotics when symptomatic after 4 hours. Only one infant who was unwell from birth, died. Eighty-one per cent of all EOS infants were treated for clinical reasons rather than for risk factors alone.ConclusionWhile both tools were poor in identifying EOS within 4 hours, NICE was superior to SRC in identifying asymptomatic cases. Currently, four out of five EOS have symptoms at first identification, the majority of whom present within 24 hours of birth. Antibiotic stewardship programmes using SRC should include enhanced observation for infants currently treated within NICE guidance.

Misidentification of S. suis as a Zoonotic Agent

BACKGROUND: Streptococcus suis is an emerging zoonotic pathogen. This bacterium commonly causes meningitis in human and is often associated with hearing and vestibular dysfunction. S. suis tends to be misidentified, leading to under-diagnosis. CASE PRESENTATION: A previously healthy 50-year-old man was admitted to one of the district hospitals in Bali Province, Indonesia, due to meningitis. He had a history of consuming homemade raw pork product two days before the onset of illness. Streptococcus mitis was identified from the cerebrospinal fluid culture by using VITEX 2 COMPACT (Biomeriuex) with a 99% probability score. This patient had clinical symptoms and risk factor identical to S. suis infection. Therefore, we performed confirmation tests for the cerebrospinal fluid by PCR (using primer specific for gdh and recN) and sequencing of those PCR products. Both of the confirmation tests showed a positive result for S. suis. CONCLUSION: There are few reports of S. suis infections in Indonesia, but we believe that the cases in Indonesia, especially Bali, are not uncommon. The under-reported cases are perhaps due to the difficulties in differentiating S. suis from other Streptococcus species by culture method, particularly Streptococcus mitis. Therefore, confirmation by PCR is necessary.

Acetazolamide-Induced Aseptic Meningitis in a Female Adolescent with Idiopathic Intracranial Hypertension: A Case Report

Drug-induced aseptic meningitis (DIAM) has been documented for many years and is considered a diagnostic and patient management challenge. Associated medications include nonsteroidal anti-inflammatory drugs, antibiotics, and monoclonal antibodies, but no cases associated with acetazolamide have been reported. We briefly review a case of a 15-year-old female patient with history of idiopathic intracranial hypertension whose symptoms of aseptic meningitis associated with the use and increase of acetazolamide. DIAM should be considered a possibility in any patient with meningeal symptoms, pleocytosis, and negative cerebrospinal fluid culture. This is the first known case linking acetazolamide to DIAM.