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[Invasive disease caused by Streptococcus pyogenes. Report of a case with cutaneous and kidney metastasis]
I Jordán1, M T García, J García
1Servicio Dermatología. Unitat Integrada Hospital Clínic-Hospital Sant Joan de Déu. Universitat de Barcelona.
Abstract:
Few cases of invasive disease due to Streptococcus pyogenes in children have been described. Greater knowledge of this disease is needed due to its increasing incidence and seriousness. New serotypes have been discovered with greater virulence due to exotoxin production and to the development of resistance to phagocytosis. We present a case of invasive disease due to S. pyogenes with bacteremia and cutaneous and kidney metastasis, in a non-immunodeficient child. The case is of interest because kidney dissemination has not been described in the literature and because evolution was satisfactory with endovenous beta-lactamica treatment during 15 days for only 48 hours. The importance of ruling out multi-organ metastatic foci, including use of urine cultures to rule out kidney involvement are highlighted. The epidemiological, pathogenic, clinical and diagnostic aspects of this entity, as reported in recent literature, are described.
Insights
Invasive Streptococcus pyogenes infections in children are rare but serious. This case highlights unusual kidney metastasis and effective, rapid treatment, emphasizing the need for thorough diagnosis.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Invasive Streptococcus pyogenes infections in children are uncommon but increasingly recognized.
- Emerging serotypes exhibit enhanced virulence through exotoxin production and resistance to phagocytosis.
- Understanding the clinical spectrum and treatment of invasive Group A Streptococcus is crucial.
Observation:
- A case of invasive Streptococcus pyogenes disease in a non-immunodeficient child presented with bacteremia and metastatic spread to the skin and kidneys.
- Renal metastasis is a previously undescribed manifestation of invasive Streptococcus pyogenes infection in pediatric cases.
- The child experienced a favorable outcome with a shortened course of intravenous beta-lactam treatment.
Findings:
- This case expands the known metastatic potential of invasive Streptococcus pyogenes to include the kidneys.
- Rapid and effective treatment with intravenous beta-lactams led to a satisfactory clinical resolution.
- Early identification of metastatic foci, including renal involvement via urine cultures, is critical for management.
Implications:
- Highlights the importance of considering Streptococcus pyogenes in pediatric invasive infections, even with unusual presentations.
- Suggests that a shorter duration of intravenous antibiotic therapy may be sufficient for invasive Streptococcus pyogenes infections.
- Emphasizes the need for comprehensive diagnostic workups to detect multi-organ involvement in invasive bacterial infections.