Spectrum of Central Nervous System Disease Caused by Streptococcus anginosus Group: A Single-Center Case Series.

BACKGROUND

To characterize the electrophysiologic and neurological outcomes of pediatric patients with central nervous system infections secondary to Streptococcus anginosus group (SAG).

METHODS

We report a retrospective case series of 15 pediatric patients admitted to the pediatric intensive care unit (PICU) with central nervous system infections caused by SAG.

RESULTS

The population was healthy with no significant comorbidities before presentation. Prodromal symptoms had an acute onset (less than four weeks), with most patients experiencing fever (93%), headache (87%), and fatigue (87%). Fourteen patients (93%) had subdural or epidural empyema, while one (7%) had ventriculitis. Nine patients (60%) underwent continuous electroencephalography recording. Seven patients (47%) had seizures, with three patients (20%) having subclinical seizures only. One patient (7%) developed epilepsy. Five patients (33%) had mild to moderate residual deficits on neurological examination at discharge. Neuropsychologic testing revealed emotional dysregulation (e.g., emotional reactivity, anxiety, depression), attention deficits, and difficulty with working memory.

CONCLUSIONS

Among our cohort, patients were previously healthy with acute onset of nonspecific symptoms. Hospitalization was typically complicated by intracranial abscesses and seizures; the prognosis was favorable, with only one third of patients experiencing neurological deficits at discharge. Neuropsychologic data showed notable psychological deficits following PICU admission.