Illustration of a child's brain protected from infection

Unmasking Hidden Dangers: Understanding Intracranial GAS Infections in Children

Rhea Morgan in Health & Wellness November 2025 • 4 min read.

"A comprehensive look at the characteristics, risks, and treatment of intracranial Group A Streptococcus (GAS) infections in US children, crucial for early detection and intervention."

Group A Streptococcus (GAS) infections are commonly known for causing superficial skin infections and sore throats. However, in rare instances, GAS can lead to severe invasive infections, including those affecting the brain. These intracranial GAS infections are particularly dangerous, often resulting in higher fatality rates and long-term neurological issues such as hearing loss, developmental delays, and motor deficits. Understanding the characteristics of these infections is crucial for early diagnosis and effective treatment.

While previous studies have hinted at the connection between intracranial infections and contiguous spread from areas like the ear or sinuses, comprehensive reviews remain limited. A recent study utilizing data from the Active Bacterial Core surveillance (ABCs) system seeks to provide a clearer picture of intracranial GAS infections among children in the United States. This research aims to systematically assess demographics, clinical presentations, diagnostic methods, treatment approaches, and outcomes to improve understanding and management of this rare condition.

This analysis is crucial because early detection and intervention are key to mitigating the severe consequences of intracranial GAS infections. By examining a large dataset spanning from 1997 to 2014, the study sheds light on the subtle yet critical factors that differentiate these infections, empowering healthcare providers and parents alike to be vigilant and informed.

Key Findings on Intracranial GAS Infections

Illustration of a child's brain protected from infection

The study, which examined data from 1997 to 2014, identified 91 cases of intracranial GAS infection among 2,596 children with invasive GAS infections, representing about 3.5% of the total. The research highlighted that these infections are more prevalent during the winter months and among children under one year old. The average annual incidence was found to be 0.07 cases per 100,000 children, underscoring the rarity of this condition.

Among the cases analyzed, the principal clinical presentations included meningitis (42%), intracranial infection following otitis media, mastoiditis, or sinusitis (41%), and ventriculoperitoneal shunt infection (17%). Alarmingly, 8% of these infections progressed to streptococcal toxic shock syndrome, and the overall case fatality rate was 15%. The most common GAS emm types identified were types 1 (31%) and 12 (13%).

Winter months see higher incidence.
Meningitis and ENT-related infections are common presentations.
Streptococcal toxic shock syndrome a significant risk.
Case fatality rate is notably high.

Several factors were identified as potential risks. The presence of a ventriculoperitoneal shunt was a notable risk factor, emphasizing the need for vigilance in children with these devices. Additionally, contiguous infections in the middle ear or sinuses were also significant risk factors, highlighting the importance of prompt treatment of these conditions to prevent further complications. Notably, the rate of intracranial GAS infection was highest among children under one year old, emphasizing the vulnerability of this age group.

The Importance of Vigilance and Rapid Response

Intracranial GAS infections in children remain a rare but severe threat, demanding vigilance from both healthcare providers and parents. The study underscores the significance of considering GAS as a potential pathogen in children presenting with parameningeal or intracranial infections, particularly those with ventriculoperitoneal shunts or recent trauma. Rapid recognition and prompt treatment are essential to improving outcomes and reducing the risk of long-term neurological sequelae. Continued research and heightened awareness are crucial in the ongoing effort to protect our youngest populations from this dangerous infection.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1093/jpids/piy108, Alternate LINK

Title: Characteristics Of Intracranial Group A Streptococcal Infections In Us Children, 1997–2014

Subject: Infectious Diseases

Journal: Journal of the Pediatric Infectious Diseases Society

Publisher: Oxford University Press (OUP)

Authors: Ruth Link-Gelles, Karrie-Ann Toews, William Schaffner, Kathryn M Edwards, Carolyn Wright, Bernard Beall, Brenda Barnes, Brenda Jewell, Lee H Harrison, Pam D Kirley, Lauren Lorentzson, Deborah Aragon, Susan Petit, Joseph Bareta, Nancy L Spina, Paul R Cieslak, Chris Van Beneden

Published: 2018-11-21

Everything You Need To Know

What are the potential long-term health consequences for children who develop intracranial Group A Streptococcus infections, and what does the study reveal about the severity of these infections?

Intracranial Group A Streptococcus infections, while rare, can lead to severe complications such as hearing loss, developmental delays, and motor deficits. The study revealed a case fatality rate of 15% among affected children, highlighting the severity and potential long-term consequences of these infections. Early detection and intervention are critical to mitigating these risks.

Did the study identify any specific times of the year or age groups when children are more susceptible to intracranial Group A Streptococcus infections?

The study identified a higher incidence of intracranial Group A Streptococcus infections during the winter months and among children under one year old. This suggests increased vulnerability during these times, possibly due to seasonal factors or the immaturity of the immune system in infants. Parents and healthcare providers should be particularly vigilant during these periods.

What were the most common clinical presentations of intracranial Group A Streptococcus infections observed in the study, and what do these findings suggest about the importance of addressing related health issues?

Meningitis was observed in 42% of cases, and 41% of intracranial Group A Streptococcus infections followed otitis media, mastoiditis, or sinusitis. Additionally, 17% of cases involved ventriculoperitoneal shunt infections. These findings emphasize the importance of promptly addressing ear, sinus infections, and shunt-related issues to prevent the spread of Group A Streptococcus to the brain.

Does the research identify specific risk factors that make children more prone to developing intracranial Group A Streptococcus infections?

Yes, the study identified ventriculoperitoneal shunts and contiguous infections in the middle ear or sinuses as significant risk factors for intracranial Group A Streptococcus infections. Children with these devices or conditions should be closely monitored for any signs of infection, and prompt treatment should be initiated if necessary. While trauma was mentioned as a factor to consider, it was not explicitly identified as a significant risk factor in the provided findings.

How does the Active Bacterial Core surveillance system contribute to understanding intracranial Group A Streptococcus infections, and what future research directions could build upon these findings to improve prevention and treatment?

The Active Bacterial Core surveillance system systematically assesses demographics, clinical presentations, diagnostic methods, treatment approaches, and outcomes to improve understanding and management of this rare condition. Future research could explore preventative measures, such as targeted vaccination strategies or improved infection control protocols, to further reduce the incidence and severity of intracranial Group A Streptococcus infections in children.