CBRCell Biology ResearchTBA2529-7627WHIOCE PUBLISHING PTE. LTD.10.18063/CBR.v7i2.1890ArticleTilapia Handling-Associated Streptococcus agalactiae Meningitis: A Case Series of Three Patientshttps://artdesignp.com/journal/CBR/7/2/10.18063/CBR.v7i2.1890ZhongHongliang,KLu2026722026-06-26The study reports three adult males (aged 47, 52, and 64 years) who presented with acute bacterial meningitis within 4 to 24 hours after sustaining tilapia-related puncture wounds. Cerebrospinal fluid (CSF) analysis consistently showed neutrophilic pleocytosis, elevated protein, and decreased glucose. All three CSF cultures yielded Streptococcus agalactiae (Group B Streptococcus, GBS) sensitive to penicillin. Blood cultures were positive in one patient. Two patients recovered completely with antibiotic therapy; the remaining patient developed post-meningitic hydrocephalus requiring ventriculoperitoneal shunting. These cases illustrate that percutaneous inoculation from fish spines can serve as a direct portal of entry for GBS into the bloodstream, subsequent crossing of the blood-brain barrier, and meningeal infection. Clinicians evaluating community-acquired meningitis in areas where tilapia is commonly handled should inquire about recent fish-related injuries and consider GBS in the differential diagnosis.Streptococcus agalactiae,Group B Streptococcus,Meningitis,Tilapia,Fish spine injury,Case report

[1] Gonçalves BP, Procter SR, Paul P, et al., 2022, Group B Streptococcus Infection During Pregnancy and Infancy: Estimates of Regional and Global Burden. Lancet Global Health, 10(6): e807–e819. [2] van Kassel MN, Bijlsma MW, Brouwer MC, et al., 2019, Community-Acquired Group B Streptococcal Meningitis in Adults: 33 Cases From Prospective Cohort Studies. Journal of Infection, 78(1): 54–57. [3] Kalimuddin S, Chen SL, Lim CTK, et al., 2017, 2015 Epidemic of Severe Streptococcus agalactiae Sequence Type 283 Infections in Singapore Associated With the Consumption of Raw Freshwater Fish: A Detailed Analysis of Clinical, Epidemiological, and Bacterial Sequencing Data. Clinical Infectious Diseases, 64(Suppl 2): S145–S152. [4] Rajendram P, Mar Kyaw W, Leo YS, et al., 2016, Group B Streptococcus Sequence Type 283 Disease Linked to Consumption of Raw Fish, Singapore. Emerging Infectious Diseases, 22(11): 1974–1977. [5] Mian GF, Godoy DT, Leal CA, et al., 2009, Aspects of the Natural History and Virulence of S. agalactiae Infection in Nile Tilapia. Veterinary Microbiology, 136(1–2): 180–183. [6] Sirimanapong W, Phan TNT, Crestani C, et al., 2023, Geographical, Temporal and Host-Species Distribution of Potentially Human-Pathogenic Group B Streptococcus in Aquaculture Species in Southeast Asia. Pathogens, 12(4): 525. [7] Al-Bayati A, Douedi S, Alsaoudi G, et al., 2020, Meningitis From Invasive Streptococcus agalactiae in a Healthy Young Adult. IDCases, 21: e00907. [8] Ide R, Kubota T, Ohtomo A, et al., 2024, Streptococcus agalactiae Meningitis in an Immunocompetent Adult: A Case Report and Literature Review. Internal Medicine, 63(9): 1301–1303. [9] Brouwer MC, Tunkel AR, van de Beek D, 2021, Community-Acquired Bacterial Meningitis. Lancet, 398(10304): e17–e27. [10] van Kassel MN, van Haeringen KJ, Brouwer MC, et al., 2020, Community-Acquired Group B Streptococcal Meningitis in Adults. Journal of Infection, 80(1): e1–e3. [11] Joyce LR, Kim S, Spencer BL, et al., 2024, Streptococcus agalactiae Glycolipids Promote Virulence by Thwarting Immune Cell Clearance. Science Advances, 10(22): eadn7848. [12] Charlet C, Echahidi F, Bouchier C, et al., 2022, Streptococcus agalactiae Infects Glial Cells and Invades the Central Nervous System via the Olfactory and Trigeminal Nerves. Frontiers in Microbiology, 13: 1088801. [13] Abdallah ESH, Metwally WGM, Abdel-Rahman MAM, et al., 2024, Streptococcus agalactiae Infection in Nile Tilapia (Oreochromis niloticus): A Review. Biology, 13(11): 914. [14] Algammal AM, Mabrok M, Almessiry BK, et al., 2025, Unraveling the Pathogenic Potential, Virulence Traits, and Antibiotic Resistance Genes of Multidrug-Resistant Streptococcus agalactiae Strains Retrieved From Nile Tilapia. BMC Microbiology, 25(1): 629. [15] He X, Wang M, Sun T, et al., 2025, Metagenomic Next-Generation Sequencing Diagnosis of Streptococcus agalactiae Meningitis in a Diabetic Patient. Cureus, 17(10): e94759. [16] Akahara O, Hennis R, Bies JJ, et al., 2024, A Rare Case of Streptococcus agalactiae Ventriculitis and Endocarditis. Cureus, 16(3): e56151. [17] Yang L, Zhang ZW, Liang Q, et al., 2025, Severe Acute Bacterial Skin and Skin Structure Infection Following Fish Spine Injury: A Case Report and Literature Review. Infection and Drug Resistance, 18: 4633–4645. [18] Duan S, Su H, Xu W, et al., 2024, Concentrations, Distribution, and Key Influencing Factors of Antibiotic Resistance Genes and Bacterial Community in Water and Reared Fish Tissues in a Typical Tilapia Farm in South China. Journal of Environmental Science and Health Part B, 59(1): 21–35.