Group B streptococcal meningitis in an adult.

Group B streptococcal meningitis in an adult Sir, Group B streptococcal infection causing acute septicaemia and meningitis is rare inadults and accounts for less than 1% of cases. Group B streptococcus is a very invasive organism which seldom causes acute inflammation at the site of entry to the body and the appearance is usually unheralded. A 45-year-old woman was admitted for varicose vein surgery. She had a history of varicose eczema and left deep vein thrombosis. She was allergic to penicillin. Spinal anaesthetic was performed asceptically and lignocaine was injected through a bacterial filter. Stripping of varicose veins was performed satisfactorily. Prophylactic subcuta-neous heparin was used. Six hours post-operatively she developed a sore throat and 18 hours later she became confused, restless, had a temperature of 38°C, neck stiffness but no focal neurological signs. A clinical diagnosis of meningitis was made and she was given intravenous ceftazidime and chloramphenicol after blood cultures had been taken. Lumbar puncture was performed aseptically under sedation. Cloudy cerebrosp-inal fluid (CSF) was obtained with 2000 white blood cells per ml (95% polymorphs), 1000 red blood cells per ml, 6 g/l protein, glucose 0.4 mmol/l; Gram-positive cocci were seen. Venous blood glucose was 10.1 mmol/l and white blood count 13.2x 10 g/1. Urea and electrolytes, liver function tests and arterial blood gases were normal. She was commenced on vancomycin and ceftrioxone and transferred to the intensive care unit.