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Brain abscess caused by Streptococcus pyogenes with atypical symptoms: a case report and literature review
Chun-Zhen Hua1, Zhi-Peng Shen2, Ming-Ming Zhou3
1Department of Infectious Diseases, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, 310003, China.
Background:
Streptococcus pyogenes is a common gram-positive bacterium, belonging to group A Streptococcus (GAS), and is responsible for causing a range of clinical conditions. Brain abscess caused by GAS is uncommon in pediatric infectious diseases, and GAS brain abscess without acute infectious symptoms has been rarely reported.
Case Presentation:
We present a case of one GAS brain abscess in a previously healthy child with unusual clinical manifestations of decreased muscle strength in the left limbs. The right frontal lobe mass lesion was resected using a microscope-based neuronavigation system. A sole defectively beta-hemolytic Streptococcus pyogenes was isolated from the lesion. The patient's peripheral blood whole-exome and the pathogen's whole-genome sequencing were performed respectively, revealing a heterozygous mutation in the interferon regulatory factor-8 (IRF8) gene in the patient and lack of hyaluronic acid capsules in Streptococcus pyogenes (genotype emm22). The patient eventually recovered after prompt surgical drainage of the abscess and appropriate antibiotic treatment.
Conclusions:
It is important to pay attention to Streptococcus pyogenes brain abscesses with mild clinical manifestations. Upon reviewing all the cases of pediatric GAS brain abscess reported in the published literature, we discovered that early diagnosis and treatment are crucial factors that impact the prognosis of GAS brain abscess.
Insights
Group A Streptococcus (GAS) brain abscess is rare in children, especially with subtle symptoms. Prompt diagnosis and treatment are vital for a good outcome in these uncommon pediatric infections.
Area of Science:
- Pediatric Infectious Diseases
- Neuroscience
- Microbiology
Background:
- Streptococcus pyogenes (Group A Streptococcus - GAS) is a common bacterium causing various infections.
- Brain abscesses due to GAS are rare in children, with few cases presenting without acute symptoms.
Purpose of the Study:
- To report a rare case of pediatric GAS brain abscess with unusual clinical presentation.
- To highlight the importance of early diagnosis and treatment for pediatric GAS brain abscess.
Main Methods:
- Surgical resection of the brain abscess using a microscope-based neuronavigation system.
- Isolation and whole-genome sequencing of Streptococcus pyogenes from the lesion.
- Whole-exome sequencing of the patient's peripheral blood.
Main Results:
- A heterozygous mutation in the IRF8 gene was identified in the patient.
- The isolated Streptococcus pyogenes (emm22 genotype) lacked hyaluronic acid capsules.
- The patient recovered after surgical drainage and antibiotic therapy.
Conclusions:
- Pediatric Streptococcus pyogenes brain abscess can present with mild or unusual symptoms.
- Early diagnosis and prompt intervention are critical for improving prognosis in pediatric GAS brain abscess cases.
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