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Group a streptococcus spinal epidural abscess during varicella
Caroline Quach1, Bruce Tapiero, Francisco Noya
1Division of Infectious Disease, Department of Pediatrics, Sainte-Justine Hospital, University of Montreal, Quebec, Canada.
Abstract:
Multiple complications of varicella have been described. Musculoskeletal complications (osteomyelitis, septic arthritis, and necrotizing fasciitis) as well as neurologic complications (ataxia, encephalitis, and transverse myelitis) are well-known. We describe the cases of 2 children, ages 18 months and 5 years, who were admitted recently to 2 pediatric hospitals in Montreal with a resolving varicella, abdominal and lumbar pain, and a refusal to walk and in whom a diagnosis of epidural abscess caused by group A streptococcus (GAS) was established. No previous case of epidural abscess caused by GAS in the context of varicella has been reported. Epidural abscesses are rare in pediatrics and are caused mainly by hematogenous spread of Staphylococcus aureus. The diagnosis in pediatrics is challenging because it is rare and does not present as classically as in adults. The prognosis is related to the presence of neurologic deficits before surgery and to the rapidity with which the diagnosis and the intervention are made. These cases highlight a new clinical association in children of epidural abscess caused by GAS and varicella. An early clinical diagnosis requires a high index of suspicion when back or abdominal pain with or without neurologic signs and symptoms occurs during or soon after varicella.
Insights
Group A Streptococcus (GAS) epidural abscess is a rare complication of varicella (chickenpox) in children. Early diagnosis is crucial for preventing neurological deficits.
Area of Science:
- Pediatric infectious diseases
- Pediatric neurology
- Clinical case reports
Background:
- Varicella (chickenpox) can lead to various musculoskeletal and neurological complications.
- Epidural abscesses are uncommon in children, typically caused by Staphylococcus aureus.
- Group A Streptococcus (GAS) is a less common pathogen for pediatric epidural abscesses.
Observation:
- Two pediatric cases presented with resolving varicella, abdominal/lumbar pain, and refusal to walk.
- Diagnosis of epidural abscess caused by GAS was established in both children.
- No prior reports link GAS epidural abscesses with varicella infections.
Findings:
- This study identifies a novel association between varicella and GAS epidural abscess in children.
- Pediatric epidural abscess diagnosis is challenging due to rarity and atypical presentations.
- Prognosis depends on early diagnosis and prompt surgical intervention.
Implications:
- Highlights a new clinical presentation of varicella complications.
- Emphasizes the need for high clinical suspicion for epidural abscess in children with varicella and back/abdominal pain.
- Suggests considering GAS as a causative agent in varicella-associated epidural abscesses.