Ruth Link-Gelles1, Karrie-Ann Toews1, William Schaffner2, Kathryn M Edwards3, Carolyn Wright1, Bernard Beall1, Brenda Barnes2, Brenda Jewell4, Lee H Harrison5, Pam D Kirley6, Lauren Lorentzson7, Deborah Aragon8, Susan Petit9, Joseph Bareta10, Nancy L Spina11, Paul R Cieslak12, Chris Van Beneden1. 1. Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia. 2. Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee. 3. Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee. 4. Minnesota Department of Health, St. Paul. 5. Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 6. California Emerging Infections Program, Oakland. 7. Georgia Department of Public Health, Atlanta. 8. Colorado Department of Public Health and Environment, Denver. 9. Connecticut Department of Public Health, Hartford. 10. New Mexico Department of Health, Santa Fe. 11. New York State Department of Health, Albany. 12. Oregon Health Authority Public Health Division, Portland.
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. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society 2018.
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. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society 2018.
Entities:
Keywords:
group A Streptococcus; mastoiditis; meningitis; sinusitis; ventriculoperitoneal shunt
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