Clinical Guidance for Children with Intracranial Infections Associated with Streptococcus Bacteria 

What You Need to Know
  • CDC is investigating a possible increase in intracranial infections in children.
  • Streptococcus bacteria have been identified in most cases, with Streptococcus intermedius being the most common cause. However, many other bacteria have been identified, and brain abscesses are often caused by infection with multiple bacteria.
  • CDC is asking clinicians to
    • Consider testing for the causative pathogen in pediatric patients with brain abscesses or subdural or epidural empyemas.
    • Report any potential cases to local or state public health authorities and hold associated clinical specimens and bacterial isolates.

In May 2022, CDC was notified of three children at a hospital in California with intracranial infections caused by Streptococcus intermedius. All the children were previously healthy and ranged in age from 11 to 13 years old at the time of hospitalization. Based on the cases from California and information gathered from additional health systems, investigators were concerned that there may be an increase in pediatric intracranial infections. However, a preliminary analysis of hospitalizations from a wide range of children’s hospitals across the United States did not find an increase in pediatric intracranial infections (unpublished data, Pediatric Health Information System [PHIS], through a collaboration with the Children’s Hospital Association [CHA]).

Additional analyses are ongoing and results may change, but the preliminary data are reassuring. More data will be collected based on information gained through a national request for cases that went out June 9, 2022. Learn more about the investigation.

Testing and reporting

CDC is asking clinicians to

  • Consider testing for the causative pathogen in pediatric patients with brain abscesses or subdural or epidural empyemas
  • Report any possible cases to their local or state public health authorities
  • Save specimens and bacterial isolates for further testing

CDC has recommendations for clinicians and laboratories about how to submit specimens for testing.

CDC is also engaging public health partner organizations to share information and make sure healthcare providers are prepared to diagnose and treat additional cases.

Report cases

Case definition: A diagnosis of brain access, epidural empyema, and/or subdural empyema in a person aged ≤18 years without prior history of neurosurgical procedures or head trauma, hospitalized on or after June 1, 2021.

Email CDCStrepInquiry@cdc.gov for reporting instructions and to obtain access to a secure folder for submitting a case report.

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

Related Pages

Page last reviewed: June 13, 2022