establish whether use of a deficient lot of medium would result in a $3000 loss in some aspect of health care. The loss could represent morbidity, mor- tality, or added hospitalization, all of which might result from errors in diag- nosis and treatment resulting from failure of the media to perform prop- erly. Justification of such an expendi- ture could not be established. The seriousness of the consequences that might result from failure to isolate Campylobacter are also difficult to as- sess. Inability to culture Neisseria gonnorhoeae or N. meningitidis could cause significant added diagnostic and therapeutic cost, morbidity, and pos- sible mortality. The higher frequency of failure of these media makes the ex- penditure for quality control measures more acceptable. It is the desire of the subcommittee that the burden of quality control of ready-to-use, commercially prepared media will be relieved by the imple- mentation of the Standard. Reference3 I. NCCLS, 1986. Quality assurance of commercially prepared microbiological culture media. Tentative Standard M22-T. National Committee for Clin- ical Laboratory Standards, Villanova, PA. Case Report Meningitis Caused by Streptococcus dysgalactiae L. Aguilar C. Martinez C. Raya J. Gil P. Alomar Microbiology Section Hospital Virgen de Lluch Palma de Mallorca, Spain Group C streptococci are an un- common cause of human disease; how- ever, they have been reported to cause endocarditis, pneumonia, osteomyelitis, and pharyngitis (8). To date, four cases of meningitis due to this organism have been reported (2, 5, 7, 9). The isolation and identification of group C streptococci is important be- cause of the organism's potential pathogenicity and because it often ex- hibits antimicrobial agent tolerance. Portnoy (6) studied 17 cases of group C streptococcal infection and showed that the poor therapeutic response to peni- cillin in 16 patients was due to peni- cillin tolerance. We report a case of meningitis caused by a group C streptococcus, Streptococcus dysgalactiae. Two days before entering the hospital, a 60-yr-old woman felt acutely ill. She was suf- fering from IgM monoclonal gammop- athy associated with chronic idiopathic thrombocytopenia. She had been sple- nectomized a year before, and was being treated with prednisone. On ad- mission she was unresponsive, menin- geal signs were absent, and she had no focal signs. Lumbar puncture revealed a turbid CSF with 5000 cells/mm 3 (90% polymorphonuclear leukocytes). The CSF glucose was 40 mg/dL and the CSF protein was 45 mg/dL. Treat- ment with intravenous cefotaxime (300 mg/kg/day) was instituted, but the pa- tient died 2 hr after the first dose. An alpha-hemolytic, catalase-negative, op- tochin-resistant, gram-positive coccus was isolated from the CSF and blood cultures. By a latex-enzymatic extrac- tion test (Streptex, Burroughs-Well- come) (4), the organism was grouped as a group C Streptococcus, and was identified biochemically as S. dysga- lactiae (3, 8) by API 50 CH and AP1 STREP (Analytab Products, Inc.). Penicillin susceptibility was determined by the broth dilution method (6). The organism failed to grow in Mueller-Hinton broth (BBL) supple- mented with Ca + + and Mg + + Min- imal inhibitory concentration (MIC) tests performed with tryptic soy broth (Difco) supplemented with 20% horse serum (6) could not be clearly read; therefore, the MIC was determined by the agar diffusion method (1). Both the MIC and minimal bactericidal concen- tration (MBC) were 0.02 Ixg of peni- cillin/mL; thus, this organism was not tolerant. Although the incidence of human in- fections caused by group C streptococci is low, Streptococcus equisimilis pro- duces disease more frequently than S. dysgalactiae, which is a common an- imal pathogen (8). Of the meningitis cases reported to date, only one was caused by S. dysgalactiae. Because our strain was optochin- resistant and alpha-hemolytic, it would have been identified as a Streptococcus, viridans group if serotyping procedures were not performed. Group C alpha- hemolytic streptococci must be identi- fied biochemically because certain alpha-hemolytic viridans streptococci share antigens in common with species in groups A, C, F, and G (3, 4). The routine battery of microbiologic tests for streptococci (i.e., catalase, sheep blood hemolysis, bacitracin, op- tochin, susceptibility to trimethoprim- sulfamethoxazole) may result in the misidentification of group C or- ganisms. Moreover, because a high percentage of group C streptococci ex- hibit tolerance, we feel that MIC, MBC, and penicillin-aminoglycoside synergy studies should be performed in selected cases. For these reasons, we recommend serologic grouping and biochemical identification of all strep- tococci recovered from blood and nor- mally sterile tissues, regardless of their hemolytic properties. ReJkrences 1. Casals, J. B. 1982. A new simplified MIC test for aerobes and anaerobes using three tablets on an agar medium. 3rd Mediterranean Congress of Chemo- therapy, Dubrounik, p. 461. 2. Chung, S. J. 1982. Meningitis caused by Streptococcus equisimilis (group C). S. Med. J. 75:769. 3. Cowan, S. T. 1974. Manual for the identification of medical bacteria, 2nd 30 0196-4399/87/$0.00 ~. 02.20 ,t 1987 Elsevier Sciencc Publi~,hin~ Co.. Inc. Clinical Microbiology Newslettel 9:4.1987