Medscape CME Activity

Group A Streptococcus (GAS) causes a variety of diseases in humans but is not widely appreciated as a cause of meningitis. During 1997–2022, ten sites participating in the Active Bacterial Core Surveillance network in the United States identified GAS meningitis cases. We calculated annual incidence and case-fatality rates (CFRs) for 320 of those cases and determined antimicrobial resistance by whole-genome sequencing. Annual incidence of GAS meningitis ranged from 0.02 to 0.07 cases/100,000 persons. Children <1 year of age had the highest average annual incidence, 0.23 cases/100,000 children. GAS meningitis had a higher CFR (19.4%) than meningitis caused by group B Streptococcus, Streptococcus pneumoniae, Neisseria meningitidis, or Haemophilus influenzae. Clindamycin resistance among GAS meningitis isolates increased from 3.2% during 1997–2002 to 17.7% during 2018–2022. Clinicians should be aware that meningitis is an uncommon but severe manifestation of invasive GAS and has a higher CFR than more established meningitis etiologies.

Reports of ocular manifestations of Lyme disease (LD) are uncommon, and signs and symptoms may be overlooked by physicians. We conducted a retrospective case series of ocular LD reported during 1988–2025. Among 27 published reports in PubMed, we noted that, in 38 cases, the most common ocular manifestation was uveitis, representing 45% of cases, followed by optic neuritis and cranial nerve palsies (including trochlear and abducens). Not all cases met Centers for Disease Control and Prevention surveillance guidelines for LD, given that some case reports were published before the current guidelines. Cases that provided microbiologic proof were 2 anterior uveitis cases, 1 case of anterior uveitis with abducens’s nerve palsy, 1 case of intermediate uveitis, and 1 case of intranuclear ophthalmoplegia. Ocular LD can have a broad variety of manifestations; therefore, physicians should be aware of those manifestations and obtain microbiologic proof for a more definitive diagnosis and epidemiologic value when possible.