Group A beta-haemolytic streptococcal acute chest event in a child with sickle cell anaemia

Area of Science:

• Pediatrics
• Infectious Diseases
• Hematology

Background:

• Acute chest syndrome (ACS) is a leading cause of mortality and hospitalization in pediatric sickle cell anaemia (SCA).
• Infections, particularly pneumonia, are common triggers for ACS.
• Emerging microbial pathogens are increasingly implicated in ACS development.

Observation:

• A 15-year-old African-American female with SCA presented with symptoms of ACS, including fever, cough, chest pain, dyspnea, RUQ pain, jaundice, and otitis media.
• Chest radiography revealed multilobar pneumonia with a left pleural effusion.
• Group A beta-haemolytic Streptococcus (GABHS) was identified in pleural and middle ear fluid cultures.

Findings:

• GABHS was confirmed as the causative agent of pneumonia and subsequent ACS in this SCA patient.
• The patient demonstrated a positive response to a comprehensive treatment regimen including antibiotics, exchange transfusion, oxygen, and surgical intervention (thoracotomy with chest tube drainage and decortication).

Implications:

• GABHS should be considered as a potential pathogen in pediatric SCA patients presenting with fever and acute chest events.
• Prompt chest X-ray and empiric antibiotic therapy targeting community-acquired pneumonia agents are recommended.
• This case highlights the importance of recognizing less common etiologies of pneumonia in SCA to guide appropriate management and improve patient prognosis.