Hutton Dana, Kameda-Smith Michelle, Afshari Fardad T, Elawadly Ahmed, Hogg Florence, Mehta Samir, Samarasekara James, Aquilina Kristian, Jeelani Noor Ul Owase, Tahir M Zubair, Thompson Dominic, Tisdall Martin M, Silva Adikarige Haritha Dulanka, Hatcher James, James Greg
1Department of Neurosurgery, Great Ormond Street Hospital for Children, London.
2School of Medicine, University of Dundee.
J Neurosurg Pediatr. 2023 Jul 7;32(4):478-487. doi: 10.3171/2023.5.PEDS23109. Print 2023 Oct 1.
Invasive group A streptococcus (iGAS) infections are associated with a high rate of morbidity and mortality. CNS involvement is rare, with iGAS accounting for only 0.2%-1% of all childhood bacterial meningitis. In 2022, a significant increase in scarlet fever and iGAS was reported globally with a displacement of serotype, causing a predominance of the emm1.0 subtype. Here, the authors report on iGAS-related suppurative intracranial complications requiring neurosurgical intervention and prolonged antibiotic therapy.
The authors performed a retrospective chart review of consecutive cases of confirmed GAS in pediatric neurosurgical patients.
Five children with a median age of 9 years were treated for intracranial complications of GAS infection over a 2-month period between November 2022 and December 2022. All patients had preceding illnesses, including chicken pox and upper respiratory tract infections. Infections included subdural empyema with associated encephalitis (n = 2), extradural empyema (n = 1), intracranial abscess (n = 1), and diffuse global meningoencephalitis (n = 1). Streptococcus pyogenes was cultured from 4 children, and 2 were of the emm1.0 subtype. Antimicrobial therapy in all patients included a third-generation cephalosporin but varied in adjunctive therapy, often including a toxin synthesis inhibitor antibiotic such as clindamycin. Neurological outcomes varied; 3 patients returned to near neurological baseline, 1 had significant residual neurological deficits, and 1 patient died.
Despite the worldwide increased incidence, intracranial complications remain rarely reported resulting in a lack of awareness of iGAS-related intracranial disease. Awareness of intracranial complications of iGAS and prompt referral to a pediatric neurology/neurosurgical center is crucial to optimize neurological outcomes.
侵袭性A组链球菌（iGAS）感染与高发病率和死亡率相关。中枢神经系统受累罕见，iGAS仅占所有儿童细菌性脑膜炎的0.2%-1%。2022年，全球报告猩红热和iGAS显著增加，血清型发生变化，导致emm1.0亚型占主导地位。在此，作者报告了需要神经外科干预和长期抗生素治疗的iGAS相关化脓性颅内并发症。
作者对儿科神经外科患者确诊为GAS的连续病例进行了回顾性病历审查。
2022年11月至2022年12月的2个月期间，5名中位年龄为9岁的儿童因GAS感染的颅内并发症接受治疗。所有患者均有前驱疾病，包括水痘和上呼吸道感染。感染包括伴有相关脑炎的硬膜下积脓（n = 2）、硬膜外积脓（n = 1）、颅内脓肿（n = 1）和弥漫性全脑膜脑炎（n = 1）。4名儿童培养出化脓性链球菌，其中2名是emm1.0亚型。所有患者的抗菌治疗均包括第三代头孢菌素，但辅助治疗各不相同，通常包括毒素合成抑制剂抗生素如克林霉素。神经学结果各不相同；3名患者恢复到接近神经学基线水平，1名有明显的残余神经功能缺损，1名患者死亡。
尽管全球发病率有所上升，但颅内并发症的报告仍然很少，导致对iGAS相关颅内疾病缺乏认识。认识到iGAS的颅内并发症并及时转诊至儿科神经科/神经外科中心对于优化神经学结果至关重要。
