美国儿童群发性 A 组链球菌颅内感染的特征：1997-2014 年。
Characteristics of Intracranial Group A Streptococcal Infections in US Children, 1997-2014.
机构信息
Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia.
Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee.
出版信息
J Pediatric Infect Dis Soc. 2020 Feb 28;9(1):30-35. doi: 10.1093/jpids/piy108.
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.
背景
关于儿童的颅内 A 组链球菌（GAS）感染，数据很少。在此，我们描述了 91 例颅内 GAS 感染患儿的人口统计学、临床和诊断特征。
方法
通过疾病控制和预防中心基于人群和实验室的主动细菌核心监测（ABCs）系统，确定了 1997 年至 2014 年期间报告的 18 岁以下人群中颅内 GAS 感染病例。使用主动、标准化病例报告表提取病历。对所有可用的分离株进行 emm 型分型。使用美国人口普查数据计算发病率。
结果
ABCs 在 18 年期间发现了 2596 例侵袭性 GAS 感染儿童；91 例（3.5%）患有颅内感染。颅内感染最常发生在冬季和<1 岁的儿童中。年平均发病率为每 10 万儿童 0.07 例。对于 83 例有进一步分类信息的患者，主要临床表现包括脑膜炎（35 [42%]）、中耳炎、乳突炎或鼻窦炎后继发颅内感染（34 [41%]）和脑室-腹腔分流感染（14 [17%]）。这些感染中有 7 例（8%）进展为链球菌中毒性休克综合征。总的病死率为 15%。这些感染中有 7 例（8%）进展为链球菌中毒性休克综合征。总的病死率为 15%。GAS emm 型 1（31%的可获得分离株）和 12 型（13%的可获得分离株）最为常见。
结论
儿童颅内（GAS）感染虽然少见，但往往很严重。颅内 GAS 感染的危险因素包括存在脑室-腹腔分流和中耳或鼻窦的相邻感染。
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