Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2025 May 9;13(5):1100.
doi: 10.3390/microorganisms13051100.

Unraveling Pediatric Group A Streptococcus Meningitis: Lessons from Two Case Reports and a Systematic Review

Lavinia Di Meglio  1 , Maia De Luca  2 , Laura Cursi  2 , Lorenza Romani  2 , Mara Pisani  3 , Anna Maria Musolino  3 , Stefania Mercadante  2 , Venere Cortazzo  4 , Gianluca Vrenna  4 , Paola Bernaschi  4 , Roberto Bianchi  5 , Laura Lancella  2
Affiliations
Review

Unraveling Pediatric Group A Streptococcus Meningitis: Lessons from Two Case Reports and a Systematic Review

Lavinia Di Meglio et al. Microorganisms. .

Abstract

Streptococcus pyogenes meningitis is a rare invasive disease, accounting for less than 2% of bacterial meningitis. We presented two case reports and conducted a systematic review using PUBMED, covering the database from its inception up to 31 December 2024, of pediatric cases of Streptococcus pyogenes meningitis. Only case reports and case series were included. Differences in clinical and laboratory parameters were compared between uneventful course and complicated admissions. A total of 57 cases were included. The median age at diagnosis was 4 years. A primary infection focus outside the brain was identified in 61.39% of cases. S. pyogenes was identified from cerebrospinal fluid in 66.66% of cases and from blood in 15.79%. Septic shock occurred in 24.56% of cases, and 36.84% had brain anatomical anomalies. All patients received broad-spectrum empiric antibiotics, while protein-synthesis inhibitors were administered in 26.31% of cases. A total of 17% of patients died, and 28.07% experienced sequelae. The identification of S. pyogenes from blood and a Phoenix Sepsis Score ≥ 2 were significantly associated with a complicated clinical course. Our findings may offer useful insights for the clinical management of Streptococcus pyogenes meningitis.

Keywords: GAS; Streptococcus pyogenes; children; group A streptococcus; meningitis; pediatrics.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Prima flowchart.
Figure 2
Figure 2
Initial presentation, primary focus of infection and clinical outcome. AOM: acute otitis media; URTI: upper respiratory tract infections.
See this image and copyright information in PMC

References

    1. Brouwer S., Rivera-Hernandez T., Curren B.F., Harbison-Price N., De Oliveira D.M.P., Jespersen M.G., Davies M.R., Walker M.J. Pathogenesis, epidemiology and control of Group A Streptococcus infection. Nat. Rev. Microbiol. 2023;21:431–447. doi: 10.1038/s41579-023-00865-7. - DOI - PMC - PubMed
    1. Cunningham M.W. Pathogenesis of group a streptococcal infections. Clin. Microbiol. Rev. 2000;13:470–511. doi: 10.1128/CMR.13.3.470. - DOI - PMC - PubMed
    1. Carapetis J.R., Steer A.C., Mulholland E.K., Weber M. The global burden of group A streptococcal diseases. Lancet Infect. Dis. 2005;5:685–694. doi: 10.1016/S1473-3099(05)70267-X. - DOI - PubMed
    1. Waddington C.S., Snelling T.L., Carapetis J.R. Management of invasive group A streptococcal infections. J. Infect. 2014;69((Suppl. S1)):S63–S69. doi: 10.1016/j.jinf.2014.08.005. - DOI - PubMed
    1. Link-Gelles R., Toews K.-A., Schaffner W., Edwards K.M., Wright C., Beall B., Barnes B., Jewell B., Harrison L.H., Kirley P.D., et al. Characteristics of Intracranial Group A Streptococcal Infections in US Children, 1997–2014. J. Pediatr. Infect. Dis. Soc. 2020;9:30–35. doi: 10.1093/jpids/piy108. - DOI - PMC - PubMed

LinkOut - more resources