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.
From the *Laboratório de Bacteriologia, Divisão de Laboratórios de Epidemiologia e Controle de Doenças, Laboratório Central do Estado do Paraná, Curitiba; †Universidade Positivo, Curitiba, Paraná, Brazil; ‡Centre for International Child Health, University of Melbourne; §Infectious diseases and Microbiology group, Murdoch Children’s Research Institute, Parkville, Melbourne, Victoria, Australia; and ¶Laboratory of Bacterial Genetics and Physiology, IBMM, Faculté des Sciences, Université Libre de Bruxelles, Brussels, Belgium.
Accepted for publication August 15, 2012.
PRS is a National Fund for Scientific Research postdoctoral researcher (“chargé de recherche FNRS”). ACS is supported by the Australian National Health and Medical Research Council. The authors have no other funding or conflicts of interest to disclose.
Address for correspondence: Rosângela Stadnick Lauth de Almeida Torres, PhD, Laboratório Central do Estado do Paraná-Lacen-PR, Rua: Sebastiana Santana Fraga, 1001, Bairro Guatupê, CEP: 83060–500, São José dos Pinhais, Paraná, Brazil. E-mail: firstname.lastname@example.org.
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