Group A Streptococcal meningitis in a neonate from a tertiary care centre

Introduction Group A streptococcus (GAS), also known as Streptococcus pyogenes causes wide range of infections more common in children than adults. Most people who acquire the infection are previously healthy individuals while some do have predisposing underlying illnesses .Streptococcus pyogenes causes invasive infections, but is a highly uncommon cause of meningitis.Case Fifteen days old baby girl presented to paediatric emergency unit at our institution with history of fever for 2 days, vomiting and irritability for 1 day. Antenatal history was uneventful. No history of symptomatic pharyngitis of any of the close family contacts including parents and other siblings or grandparents.On examination child was irritable and afebrile,anterior fontanel was bulging and there was no neurological deficit. Vital signs were stable, oedema was present on the right dorsal side near the wrist. Child was admitted with working diagnosis of meningitis which was confirmed by Cerebrospinal fluid fluid (CSF) examination. CSF showed increased White Blood Cell count (t.wbc 820cumm t.rbc 70cumm 60 crenation polymorphs 80 lymph 20 bacteria present ) with neutrophilic predominance.Cerebrospinal Spinal Fluid protein of 679 mg and sugar of less than 5 mg. Latex agglutination performed on CSF was negative for Hemophillus influenzae type b, Neisseria meningitides, Escherichia Coli, Streptococcus group B and Streptococcus pneumoniae. CSF culture grew of beta-haemolytic streptococcus susceptible to penicillin, grouping was performed and reported as Group A Streptococcus.Conclusion GAS meningitis is uncommon but serious disease affecting the older neonates.GAS meningitis continues to occur sporadically in children therefore paediatricians should be aware of GAS as a cause of acute meningitis and also that the life-threatening manifestations of invasive GAS disease in children can develop a fulminant form of meningitis associated with multisystem failure.GAS should be considered as a differential diagnosis of neonatal sepsis and meningitis. Prompt and appropriate treatment helps to reduce complications and decrease mortality rates