Pediatric Central Nervous System Infections Due to Group A Streptococcus: A Systematic Review and Meta-Analysis.

Authors

Filippos Filippatos, Sofia Zori, Athanasios Michos

Published in

The Pediatric infectious disease journal. Sep 17, 2026. Epub Sep 17, 2026.

Abstract

The purpose of this systematic review is to synthesize observational evidence on pediatric group A Streptococcus (Streptococcus pyogenes-GAS) central nervous system (CNS) infections regarding epidemiologic, clinical and microbiological characteristics.
A systematic review and meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for studies up to June 2026. Eligible studies reported pediatric patients 0-18 years of age with microbiologically confirmed CNS GAS infection. Observational studies and case reports/series were synthesized descriptively and were not included in the meta-analysis.
Twenty-six independent cohorts were included in the meta-analysis, and 80 observational studies and case reports/series were additionally used for the descriptive analysis. Nine pediatric bacterial meningitis cohorts (N = 5369), including 55 GAS cases, were analyzed, and random-effects pooled proportion for GAS meningitis was 2.4% [95% confidence interval (CI): 1.1-4.9; I2=77.0%; Q-test P < 0.001]. Seventeen pediatric invasive GAS (iGAS) cohorts (N = 5496), including 216 CNS GAS cases, were analyzed, and random-effects pooled proportions for GAS meningitis was 4.4% (95% CI: 3.3-5.8; I2=63.4%; Q-test P < 0.001). Epidemiologic characteristics did not differ significantly between children included in the meta-analysis and in observational cohorts. In the combined descriptive analysis, 158/300 children (52.7%) were female. Among 289 children with age-group data, 144/289 (49.8%) were ≥5 years, 75/289 (26.0%) were 1-4 years and 70/289 (24.2%) were <1 year old. Mortality was 44/265 (16.6%). Among 156 typed isolates/cases, emm1 (62/156, 39.7%) and emm12 (24/156, 15.4%) predominated.
Pediatric CNS GAS infection is uncommon but clinically severe and frequently underrecognized. Early identification could optimize management and prevent complications.

PMID:
42750432
Bibliographic data and abstract were imported from PubMed on 17 Sep 2026.

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