Endogenous endophthalmitis complicating Streptococcus equi subspecies zooepidemicus meningitis: a case report

Abstract

BackgroundStreptococcus equi subspecies zooepidemicus (Streptococcus zooepidemicus) is a rare cause of meningitis in humans. Humans mainly get infected by contact with an animal source or by ingestion of unpasteurized dairy products. In rare cases, bacterial meningitis can be complicated by endogenous endophthalmitis which is frequently associated with a poor visual prognosis.Case presentationA 73 year old male Caucasian patient presented with clinical signs indicative of bacterial meningitis. Blood and cerebrospinal fluid cultures yielded beta-hemolytic, catalase-negative cocci. The strain was identified as Streptococcus zooepidemicus. The patient was likely infected by contact with a sick horse. Under antibiotic treatment, his general condition improved rapidly. Early after hospital admission, however, he began seeing a black spot in his left eye’s central visual field. An ophthalmological examination revealed signs of endogenous endophthalmitis and so the patient underwent vitrectomy. Despite treatment, the visual acuity of his left eye remained severely impaired. He showed no further neurological deficits at hospital discharge.ConclusionMeningitis caused by Streptococcus zooepidemicus is rare with only 27 previously published adult cases in the literature. Of note, this report constitutes the third description of endogenous endophthalmitis associated with Streptococcus zooepidemicus meningitis. Thus, endogenous endophthalmitis may represent a comparatively common complication of meningitis caused by this microorganism.

Streptococcus equi subspecies zooepidemicus Meningitis, Septicemia, and Brain Infarcts in a Costa Rican Infant

“…We actualized this data with the cases published in PubMed since then and our two cases, with especial interest in the reported cases of infants under one year of age. Using the same words in a literature search in PubMed, actually there are 37 reported cases of S. equi meningitis caused by both subspecies between 1978 and 2021, 32 of which were caused by subspecies zooepidemicus, and three caused by subspecies equi (two cases were reported as S. equi meningitis but did not distinguish between subspecies) [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]. S. equi meningitis in children is especially infrequent as the majority of cases reported have been in adult patients (>70 years: 14 patients; 40-69 years: 10 patients; 20-39 years: six patients; 10-19 years: three patients; 1-9 years: 0 patients), and only four cases were under one year of age [3,5,6,18].…”

Meningoencephalitis with Streptococcus equi Subspecies equi Leading to a Dural Arteriovenous Fistula

“…A human CNS infection caused by GCS is very rare, with fewer than 50 cases reported in the literature [1,[18][19][20][21][22][23][24][25][26]. Almost all cases of bacterial meningitis are caused by subspecies of zooepidermicus; complications have occurred in these cases, which are most commonly distant infection foci, such as endophthalmitis and endocarditis.…”

Group C Streptococcus dysgalactiae subsp.equisimilis (SDSE) Endocarditis with Endogenous Endophthalmitis and Aortic Root Abscess

“…Overall, 44% had endocarditis with 62% having mitral valve involvement but no abscess. Twelve of EE patients had bilateral eye involvement of whom 8 (33% of total) had total loss of vision [[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21],23].…”