OBJECTIVE: To characterize the epidemiologic burden and the molecular determinants of group A streptococcal (GAS) meningitis among the pediatric population of the state of Paraná, Brazil. METHODS: Clinical and epidemiologic data were gathered by a compulsory notification system during the period 2003 to 2011. Bacterial identification, antibiotic resistance profile, emm-typing, pulsed-field gel electrophoresis typing and virulence profile were analyzed by a central reference laboratory. A review of published pediatric cases of GAS meningitis from the last 45 years was undertaken and compared with the Brazilian series. RESULTS: The incidence of GAS meningitis among the pediatric population was 0.06 cases per 100,000 children per year and was associated with a case fatality rate of 43%. Neonatal age and the presence of an associated toxic shock syndrome were identified as risk factors for death. A distant focus of infection was present in more than half of the patients in the literature and in 36% in the Brazilian case series. A high diversity of emm-types was associated with GAS meningitis in Brazil. No single virulence determinant could be associated with death. CONCLUSIONS: GAS meningitis is associated with high mortality and with a high diversity of GAS emm-types and virulence determinants in Brazil.
OBJECTIVE: To characterize the epidemiologic burden and the molecular determinants of group A streptococcal (GAS) meningitis among the pediatric population of the state of Paraná, Brazil. METHODS: Clinical and epidemiologic data were gathered by a compulsory notification system during the period 2003 to 2011. Bacterial identification, antibiotic resistance profile, emm-typing, pulsed-field gel electrophoresis typing and virulence profile were analyzed by a central reference laboratory. A review of published pediatric cases of GAS meningitis from the last 45 years was undertaken and compared with the Brazilian series. RESULTS: The incidence of GAS meningitis among the pediatric population was 0.06 cases per 100,000 children per year and was associated with a case fatality rate of 43%. Neonatal age and the presence of an associated toxic shock syndrome were identified as risk factors for death. A distant focus of infection was present in more than half of the patients in the literature and in 36% in the Brazilian case series. A high diversity of emm-types was associated with GAS meningitis in Brazil. No single virulence determinant could be associated with death. CONCLUSIONS:GAS meningitis is associated with high mortality and with a high diversity of GAS emm-types and virulence determinants in Brazil.
Authors: Ruth Link-Gelles; Karrie-Ann Toews; William Schaffner; Kathryn M Edwards; Carolyn Wright; Bernard Beall; Brenda Barnes; Brenda Jewell; Lee H Harrison; Pam D Kirley; Lauren Lorentzson; Deborah Aragon; Susan Petit; Joseph Bareta; Nancy L Spina; Paul R Cieslak; Chris Van Beneden Journal: J Pediatric Infect Dis Soc Date: 2020-02-28 Impact factor: 3.164