[Clinical characteristics of intracranial suppurative infections caused by Streptococcus intermedius in 4 children].

Objective: To investigate the clinical features, therapeutic strategies, and outcomes of intracranial suppurative infections caused by Streptococcus intermedius (S. intermedius) in children. Methods: A case series study was conducted involving 4 children diagnosed with central nervous system (CNS) infections attributed to S. intermedius at the Capital Center for Children's Health, Capital Medical University from January 2020 to January 2026. Their demographics, clinical presentations, laboratory findings, neuroimaging features, microbiological results, treatment regimens, and prognoses were reviewed. Results: Among 4 children 3 were male and 1 was female, aged 10-15 years. All 4 children presented acutely with fever and headache as the initial symptoms; 3 children presented with vomiting, 2 children with drowsiness and seizures. Cerebrospinal fluid (CSF) analysis showed elevated white blood cell counts in all 4 children, elevated protein levels in 3 children. Brain MRI revealed sinusitis in all 4 children, with predominant right-sided involvement. All intracranial suppurative lesions were adjacent to the right-sided sinus inflammatory foci, including multiple brain abscesses in 1 child, subdural empyema in 2 children, and concurrent brain abscess with subdural empyema in 1 child. S. intermedius was confirmed in all 4 children via various microbiological methods: metagenomic next-generation sequencing (mNGS) of subdural pus in 1 child, targeted NGS (tNGS) of CSF in 1 child, culture of deep sinus pus obtained intraoperatively in 1 child, and both culture and tNGS of brain abscess pus in the remaining child. All 4 children received comprehensive treatment, including targeted antimicrobial therapy, anticonvulsant therapy, intracranial pressure reduction management, and multidisciplinary surgical interventions including craniotomy with abscess excision, burr-hole drainage of subdural empyema, and endoscopic sinus surgery. One child developed secondary hemophagocytic lymphohistiocytosis during the disease course. After a follow-up period of 1.5-5.5 years, all 4 children achieved clinical recovery, resumed normal academic and daily activities, and exhibited no significant neurological sequelae. Conclusions: Pediatric intracranial infections caused by Streptococcus intermedius primarily affecting older children and adolescents. These infections are highly associated with adjacent infectious foci, particularly sinusitis, and exhibiting a propensity for localized abscesses or empyema formation. Timely and targeted antibiotic therapy coupled with surgical intervention is associated with favorable prognosis in this population.