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[Severe cutaneous Streptococcus pyogenes infections in the child: results of a multicenter survey]
A Marie-Cardine1, E Mallet, K Billiemaz
1Service de réanimation pédiatrique, centre hospitalier universitaire de Saint-Etienne, avenue A.-Raimond, 42055 Saint-Etienne, France.
Insights
Severe skin infections caused by Streptococcus pyogenes, including cellulitis and necrotizing fasciitis, are rare in children. Early surgical intervention is crucial for necrotizing fasciitis, while penicillin is effective for cellulitis.
Area of Science:
- Pediatric infectious diseases
- Dermatology
- Microbiology
Context:
- Increasing incidence of severe cutaneous infections due to Streptococcus pyogenes in adults since 1980.
- Limited data on pediatric cases of cellulitis and necrotizing fasciitis caused by S. pyogenes.
Purpose:
- To assess pediatric cases of severe cutaneous infections, specifically cellulitis and necrotizing fasciitis, caused by Streptococcus pyogenes.
- To analyze the clinical presentation, diagnosis, treatment, and outcomes of these infections in children.
Summary:
- A retrospective survey (1990-2000) identified 3 cases of necrotizing fasciitis and 15 of cellulitis in pediatric centers.
- Varicella lesions were associated in 30% of cases; diagnosis was confirmed by local samples or blood cultures.
- No sequelae or deaths were observed, with treatment involving intravenous antibiotics, primarily penicillin.
Impact:
- Confirms the rarity of these infections in children, though frequency may be underestimated due to diagnostic challenges.
- Highlights varicella lesions as a common site of infection and the diagnostic similarity between cellulitis and necrotizing fasciitis.
- Emphasizes the importance of early surgical intervention for necrotizing fasciitis and penicillin therapy for cellulitis for favorable outcomes.
Unlabelled:
To assess pediatric cases of severe cutaneous infections due to Streptococcus pyogenes. Since the beginning of 1980, the incidence of cellulitis and necrotizing fasciitis due to S. pyogenes has increased in adults. Serotyping of obtained isolates are in most cases M1, M3 or M5 protein.
Patients And Method:
A retrospective (1990-2000) survey was carried out in pediatric hospital centers.
Results:
Three cases of necrotizing fasciitis and 15 of cellulitis were observed. In 30% of the cases, vancella lesions were associated; in the other cases, minor wounds were the site of the infection. Bacteriologic diagnosis was made by local samples in 14 cases; blood cultures were positive in four cases. In 11 cases, initial intravenous treatment consisted of third generation cephalosporin, in six cases of penicillin M or G and in one case of fusidic acid. In the second time, penicillin M was perfused in the majority of the cases. Mean duration of intravenous antibiotics perfusion was 15 days. There were no sequelae or death in this survey.
Conclusions:
Despite this study had limited epidemiological characteristics, it confirms that these two infections are rare. The frequency is probably underestimated, due to the difficulty in performing a diagnosis. The major site of infection was the varicella lesion. These two infections are so similar that it is frequent to mistake one infection for the other. Nonsteroidal anti-inflammatory drugs and site of infections did not influence prognosis. The treatment of cellulitis is penicillinotherapy whereas in necrotizing fasciitis early major surgery is often correlated with the rate of survival.