Group A Streptococcus Meningitis Following Arnold-Chiari Correction Surgery: A Case Report

Figueiredo, Rafael; Soares, Joana; Sarmento, Alzira; Ferreira, Paula Regina

doi:10.22038/ijp.2020.50335.4005

Group A Streptococcus Meningitis Following Arnold-Chiari Correction Surgery: A Case Report

Authors

Rafael Figueiredo ¹

Joana Soares ²

Alzira Sarmento ³

Paula Regina Ferreira ³

¹ Department of Pediatrics, Centro Materno-Infantil do Norte Albino Aroso, Centro Hospitalar Universitário do Porto, Porto, Portugal.

² Department of Pediatrics, Centro Hospitalar do Tâmega e Sousa, Penafiel, Portugal.

³ Department of Neonatal and Pediatric Intensive Care, Centro Materno-Infantil do Norte Albino Aroso, Centro Hospitalar Universitário do Porto, Porto, Portugal.

10.22038/ijp.2020.50335.4005

Abstract

Group A Streptococcus (GAS) can cause invasive disease but rarely causes meningitis. Here we report a three-year-old girl with a GAS meningitis after Arnold-Chiari type I corrective surgery. Six days after surgery she presented fever, headache, vomiting and surgical wound inflammatory signs. A cerebrospinal fluid (CSF) collection with a fistulous path to skin was identified and GAS was found in blood and CSF cultures. Despite targeted antibiotherapy, due to lack of improvement and difficult management of the CSF fistula, she needed to be submitted to several surgical corrections and increased antibiotherapy spectrum. Despite the low risk in acquiring bacterial meningitis after neurosurgery, these procedures may be a direct route for infection. Surgery complications like a fistula are a known risk factor for infection and although uncommon, GAS meningitis may be difficult to manage and can cause serious morbidity.

Keywords

Arnold-Chiari type I malformation surgery, Group A Streptococcus invasive disease

Group A Streptococcus meningitis