Group A beta-hemolytic streptococcus meningitis: clinical and microbiological features of nine cases.

Group A beta-hemolytic streptococcus (GAS) meningitis is a rare disease in adults. We conducted a retrospective study to describe clinical and microbiological features of nine cases of GAS meningitis in Switzerland. Of nine patients, six had neurosurgical conditions, and five had upper respiratory tract infections. Eight cases were community-acquired. The outcome of GAS meningitis was favorable; only one patient died of neurosurgical complications. No patient presented with toxic shock syndrome. Serotyping failed to reveal a dominant strain, and genotyping revealed that two strains carried the gene encoding the streptococcal pyrogenic exotoxin C and that one strain carried the gene encoding the streptococcal pyrogenic exotoxin A. Our observations suggest that GAS meningitis in adults is associated with neurosurgical conditions and/or an upper respiratory tract infection.