Kristian AquilinaDepartment of Neurosurgery, Great Ormond Street Hospital for Children, London; Great Ormond Street Institute of Child Health, University College London; and
Noor ul Owase JeelaniDepartment of Neurosurgery, Great Ormond Street Hospital for Children, London; Great Ormond Street Institute of Child Health, University College London; and
M. Zubair TahirDepartment of Neurosurgery, Great Ormond Street Hospital for Children, London; Great Ormond Street Institute of Child Health, University College London; and
Dominic ThompsonDepartment of Neurosurgery, Great Ormond Street Hospital for Children, London; Great Ormond Street Institute of Child Health, University College London; and
Martin M. TisdallDepartment of Neurosurgery, Great Ormond Street Hospital for Children, London; Great Ormond Street Institute of Child Health, University College London; and
Adikarige Haritha Dulanka SilvaDepartment of Neurosurgery, Great Ormond Street Hospital for Children, London; Great Ormond Street Institute of Child Health, University College London; and
Search for other papers by Adikarige Haritha Dulanka Silva in jns Google Scholar PubMedClose
MBBChir, MPhil
,
James Hatcher
James HatcherGreat Ormond Street Institute of Child Health, University College London; and Department of Microbiology, Virology and Infection Control, Great Ormond Street Hospital, London, United Kingdom
Greg JamesDepartment of Neurosurgery, Great Ormond Street Hospital for Children, London; Great Ormond Street Institute of Child Health, University College London; and
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 theemm1.0subtype. Here, the authors report on iGAS-related suppurative intracranial complications requiring neurosurgical intervention and prolonged antibiotic therapy.
开云体育世界杯赔率
The authors performed a retrospective chart review of consecutive cases of confirmed GAS in pediatric neurosurgical patients.
RESULTS
五个孩子和一个9年的年龄中位数是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 pyogeneswas cultured from 4 children, and 2 were of theemm1.0subtype. 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.
CONCLUSIONS
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.
ABBREVIATIONS
CRP = C-reactive protein;GAS = group A streptococcus;iGAS = invasive GAS;VP = ventriculoperitoneal.
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