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Published on: September 11, 2020
Group A Streptococcal meningitis in children: a short case series and systematic review
Zhen-Zhen Dou1,2, Wanrong Li1,2, Hui-Li Hu1,2
1Department of Infectious Diseases, Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Ministry of Education, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
Background:
Group A streptococcal(GAS) meningitis is a severe disease with a high case fatality rate. In the era of increasing GAS meningitis, our understanding about this disease is limited.
Purpose:
To gain a better understanding about GAS meningitis.
Methods:
Five new cases with GAS meningitis were reported. GAS meningitis related literatures were searched for systematic review in PUBMED and EMBASE. Case reports and case series on paediatric cases were included. Information on demographics, risk factors, symptoms, treatments, outcomes, and emm types of GAS was summarized.
Results:
Totally 263 cases were included. Among 100 individuals, 9.9% (8/81) had prior varicella, 11.1% (9/81) had anatomical factors, and 53.2% (42/79) had extracranial infections. Soft tissue infections were common among infants (10/29, 34.5%), while ear/sinus infections were more prevalent in children ≥ 3 years (21/42, 50.0%). The overall case fatality rate (CFR) was 16.2% (12/74). High risk of death was found in patients with shock or systemic complications, young children(< 3 years) and cases related to hematogenic spread. The predominate cause of death was shock(6/8). Among the 163 patients included in case series studies, ear/sinus infections ranged from 21.4 to 62.5%, while STSS/shock ranged from 12.5 to 35.7%, and the CFR ranged from 5.9 to 42.9%.
Conclusions:
A history of varicella, soft tissue infections, parameningeal infections and CSF leaks are important clinical clues to GAS in children with meningitis. Young children and hematogenic spread related cases need to be closely monitored for shock due to the high risk of death.
Insights
Group A Streptococcus (GAS) meningitis is a severe infection. Key risk factors include varicella, soft tissue infections, and CSF leaks, with young children and hematogenic spread posing higher mortality risks.
Area of Science:
- Pediatric Infectious Diseases
- Bacterial Meningitis Research
- Epidemiology of Streptococcal Infections
Background:
- Group A Streptococcus (GAS) meningitis is a critical illness with a high mortality rate.
- Understanding of GAS meningitis remains limited despite its increasing prevalence.
Purpose of the Study:
- To enhance comprehension of GAS meningitis through a comprehensive review.
- To identify key risk factors, clinical presentations, and outcomes associated with GAS meningitis.
Main Methods:
- A systematic literature review of PUBMED and EMBASE was conducted for GAS meningitis cases.
- Included were case reports and series focusing on pediatric populations.
- Data on demographics, risk factors, symptoms, treatments, outcomes, and emm types were extracted and summarized.
Main Results:
- The review encompassed 263 cases of GAS meningitis.
- Identified risk factors included prior varicella (9.9%), anatomical factors (11.1%), and extracranial infections (53.2%).
- Infants commonly presented with soft tissue infections (34.5%), while older children (≥3 years) more frequently had ear/sinus infections (50.0%). The overall case fatality rate was 16.2%, with shock being the primary cause of death.
Conclusions:
- Clinical indicators for GAS meningitis in children include a history of varicella, soft tissue infections, parameningeal infections, and CSF leaks.
- Young children and cases involving hematogenic spread require vigilant monitoring for shock due to elevated mortality risk.
