Group A streptococcal meningitis.

Meningitis due to group A streptococci occurs uncommonly. We report two cases, one in a patient with otitis media and the other in a patient with bullous pemphigoid. Nineteen cases in the English-language literature from the past decade plus our two cases are reviewed. In 17 patients, an associated illness was present, most often otitis media or pharyngitis. When performed, gram staining of the cerebrospinal fluid and cultures of blood usually yielded organisms. Cerebrospinal fluid was acellular in two patients. Of 21 patients, 20 survived. Antibiotic therapy, which consisted of penicillin for most patients, was effective. Ceftriaxone may be an alternative agent. Neurologic sequelae occurred more often in children than in adults.