Pediatric Invasive Group A Streptococcus Infections with Central Nervous System Involvement: A Single Institution Case Series in Southern New England.

Pediatric invasive Group A Streptococcus (iGAS) infections are rare, affecting sterile sites including the central nervous system (CNS), and cause significant morbidity and mortality. An increased incidence of pediatric iGAS infections, including cases with CNS involvement, has been noted following the COVID-19 pandemic both domestically and internationally. Regional New England iGAS data specific to pediatric populations have been limited. This case series describes three pediatric cases of iGAS with CNS involvement which presented within the same two-month period in early 2025, all from within 20 miles in Massachusetts. All were initially admitted to the pediatric intensive care unit, patients had meningitis and subdural collections on brain imaging, and subsequently required at least four weeks of intravenous antibiotics. One underwent surgical intervention. All three had seizures requiring long-term anti-epileptic therapy, and each had residual symptoms, including seizures, focal weakness, and developmental delay. GAS infections with intracranial involvement are often severe and life-threatening. This series of three pediatric intracranial iGAS cases is particularly unique due to their similar presentations, timing, and geographic proximity. With recent literature indicating rising rates of iGAS infections globally and our regional experience, GAS should be considered a potential culprit for patients presenting with invasive bacterial infections.