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. 2020 Feb 28;9(1):30-35.
doi: 10.1093/jpids/piy108.

Characteristics of Intracranial Group A Streptococcal Infections in US Children, 1997-2014

Ruth Link-Gelles  1 , Karrie-Ann Toews  1 , William Schaffner  2 , Kathryn M Edwards  3 , Carolyn Wright  1 , Bernard Beall  1 , Brenda Barnes  2 , Brenda Jewell  4 , Lee H Harrison  5 , Pam D Kirley  6 , Lauren Lorentzson  7 , Deborah Aragon  8 , Susan Petit  9 , Joseph Bareta  10 , Nancy L Spina  11 , Paul R Cieslak  12 , Chris Van Beneden  1
Affiliations

Characteristics of Intracranial Group A Streptococcal Infections in US Children, 1997-2014

Ruth Link-Gelles et al. J Pediatric Infect Dis Soc. .

Abstract

Background: Few data on intracranial group A Streptococcus (GAS) infection in children are available. Here, we describe the demographic, clinical, and diagnostic characteristics of 91 children with intracranial GAS infection.

Methods: Cases of intracranial GAS infection in persons ≤18 years of age reported between 1997 and 2014 were identified by the Centers for Disease Control and Prevention's population- and laboratory-based Active Bacterial Core surveillance (ABCs) system. Medical charts were abstracted using a active, standardized case report form. All available isolates were emm typed. US census data were used to calculate rates.

Results: ABCs identified 2596 children with invasive GAS infection over an 18-year period; 91 (3.5%) had an intracranial infection. Intracranial infections were most frequent during the winter months and among children aged <1 year. The average annual incidence was 0.07 cases per 100000 children. For 83 patients for whom information for further classification was available, the principal clinical presentations included meningitis (35 [42%]), intracranial infection after otitis media, mastoiditis, or sinusitis (34 [41%]), and ventriculoperitoneal shunt infection (14 [17%]). Seven (8%) of these infections progressed to streptococcal toxic shock syndrome. The overall case fatality rate was 15%. GAS emm types 1 (31% of available isolates) and 12 (13% of available isolates) were most common.

Conclusions: Pediatric intracranial (GAS) infections are uncommon but often severe. Risk factors for intracranial GAS infection include the presence of a ventriculoperitoneal shunt and contiguous infections in the middle ear or sinuses.

Keywords: group A Streptococcus; mastoiditis; meningitis; sinusitis; ventriculoperitoneal shunt.

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Conflict of interest statement

Potential conflicts of interest. All authors: No reported conflicts of interest. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.

Figures

Figure 1.
Figure 1.
Rates (cases per 100 000) of invasive group A Streptococcus (GAS) infection among children aged ≤18 years and percentages of those GAS infections that were intracranial, according to calendar year—Active Bacterial Core surveillance, 2004–2014.
Figure 2.
Figure 2.
Percentages of invasive group A Streptococcus (GAS) cases reported, according to month, for intracranial versus nonintracranial infections among children aged ≤18 years—Active Bacterial Core surveillance, 1997–2014
See this image and copyright information in PMC

References

    1. Quesnel S, Nguyen M, Pierrot S, et al. Acute mastoiditis in children: a retrospective study of 188 patients. Int J Pediatr Otorhinolaryngol 2010; 74:1388–92. - PubMed
    1. de Almeida Torres RS, Fedalto LE, de Almeida Torres RF, et al. Group A Streptococcus meningitis in children. Pediatr Infect Dis J 2013; 32:110–4. - PubMed
    1. Baraldés MA, Domingo P, Mauri A, et al. Group A streptococcal meningitis in the antibiotic era. Eur J Clin Microbiol Infect Dis 1999; 18:572–8. - PubMed
    1. Levy C, Bidet P, Bonacorsi S, Cohen R; Bacterial Meningitis Study Group. Group A streptococcal meningitis in children: French surveillance network from 2001 to 2012. Pediatr Infect Dis J 2013; 32:1041–2. - PubMed
    1. Nigrovic LE, Kuppermann N, Malley R; Bacterial Meningitis Study Group of the Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. Children with bacterial meningitis presenting to the emergency department during the pneumococcal conjugate vaccine era. Acad Emerg Med 2008; 15:522–8. - PubMed

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