Severe Necrotizing Pneumonia in Children, Houston, Texas, USA

his case is difficult. Meningitis in patients with inner ear malformations is associated with bacteria (e.g., S. pneumoniae and Haemophilus influenzae) that colonize the upper airways. The prevalence of oropharyngeal colonization with GBS is low (≈5%), explaining the rarity of GBS meningitis (10). Unlike for pneumococcal meningitis, which can be prevented at least partially by vaccination, no vaccine is available for GBS. Our report adds another example to the growing spectrum of invasive GBS disease beyond infancy. GBS is uniformly susceptible to penicillin; therefore, treatment directed at common causes of bacterial meningitis is also appropriate for GBS (1,10). Cochlear implant recipients with symptoms of fever, otitis media, or headache should be carefully assessed; if meningitis is diagnosed, GBS should be considered as a possible causative organism.