Clinical Guidance for Children with Intracranial Infections Associated with Streptococcus bacteria
- CDC investigated a possible increase in intracranial infections in children.
- There was a large peak in infections during winter 2022–2023 compared to what was usually seen before the COVID-19 pandemic.
- High levels of respiratory viruses spreading among children during that time may have contributed to the increase. All children should be up to date with recommended vaccinations, including influenza and COVID-19.
- Despite this increase, intracranial infections remain rare in children.
- Brain abscesses are often caused by infection with multiple bacteria. Streptococcus bacteria, including S. intermedius, are known pathogens that can cause these types of infections.
Learn more about the investigation.
About Streptococcus bacteria causing intracranial infections
S. intermedius rarely causes illness but is known to cause abscesses and subdural and epidural empyemas. These bacteria most commonly cause abscesses in the liver and brain. They can also cause endocarditis. S. intermedius can affect people of all ages and cause severe illness in otherwise healthy people.
S. pneumoniae can cause many types of infections, ranging from otitis media and sinusitis to pneumonia, bacteremia, and meningitis. Most pneumococcal infections are mild, but some can be severe. Anyone can get pneumococcal disease but being younger than 2 years old or 65 years or older or having certain medical conditions can increase risk.
Learn more about pneumococcal disease.
Transmission
Pathogens that can cause intracranial infections, such as S. intermedius, are commonly found in the nose, mouth, and throat. These bacteria can enter the body and spread to the brain or the subdural or epidural space
- Through the bloodstream from an infection in other parts of the body, such as ears, eyes, sinuses, or teeth
- By entering the brain or subdural or epidural space directly through an open wound in the head
Diagnosis
To confirm a brain abscess or epidural or subdural empyema, use diagnostic tests, such as
- Magnetic resonance imaging (MRI)
- Computed tomography (CT) scan
- Blood tests
- Lumbar puncture
Treatment
Treat brain abscesses and subdural and epidural empyemas with surgery and antibiotics.
Complications
Even with treatment, intracranial infections can sometimes lead to
- Long-term neurological problems, such as nerve damage resulting in weakness or paralysis
- Sepsis
- Death, especially if not promptly treated
Prevention
Provide prompt treatment of suspected bacterial sinusitis, severe otitis media, or orbital cellulitis. These infections are predisposing factors for an intracranial abscess.
Make sure pediatric patients are up to date with all recommended vaccines, including influenza and COVID-19.