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Mastoiditis — an infection of the bone behind the ear — is the leading cause of Group A Streptococcus (GAS) spreading to the brain in children, according to new research presented at IDWeek 2026. A review of 864 iGAS cases found that 1 in 4 children with intracranial GAS developed lasting neurological problems, most commonly seizures. The good news: unlike prior studies showing 15% mortality, no deaths were reported in this cohort.
Ear infections are sending kids' Group A Strep to the brain
Mastoiditis — the infection of the bone just behind the ear — is the most common gateway for Group A Streptococcus (GAS) to reach the brain in children, according to new data presented at IDWeek 2026. Researchers at Texas Children's Hospital reviewed a decade of cases and found that invasive intracranial GAS, while rare, carries serious neurological consequences.
Among 28 identified cases of intracranial GAS (out of 864 total iGAS cases from 2013–2023), mastoiditis accounted for 71.4% of infections. Children with hematogenous meningitis — where bacteria spread through the bloodstream — fared the worst, with over 90% requiring ICU admission and longer fever duration even after antibiotics.
By the Numbers:
Why it matters: With invasive GAS on the rise since 2022, clinicians need to be alert to ear and sinus infections as potential entry points for life-altering brain complications in children — especially in the post-pandemic era of shifting disease patterns.
