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Emergence of invasive group A streptococcal disease among young children
W Novotny1, H Faden, L Mosovich
1Department of Pediatrics, State University of New York, School of Medicine, Buffalo.
Insights
A highly invasive strain of group A streptococci caused severe invasive disease in young children, including pneumonia, arthritis, and toxic shock. All children survived, but the findings highlight the emergence of aggressive bacterial strains.
Area of Science:
- Pediatrics
- Infectious Diseases
- Microbiology
Background:
- Group A Streptococcus (GAS) is a significant bacterial pathogen.
- Invasive GAS disease can lead to severe complications in children.
Observation:
- Eight pediatric cases of invasive GAS disease occurred over three months (February-April 1990).
- Clinical presentations included pneumonia, osteomyelitis, septic arthritis, epiglottitis, and sepsis.
- Three cases occurred post-chickenpox; three children presented in shock, one with toxic shock-like symptoms.
Findings:
- Bacteremia was present in six children.
- Exotoxin production (A, B, C) varied among four tested isolates.
- The study identified a reappearance of a highly invasive GAS strain.
Implications:
- This invasive GAS strain can cause diverse severe clinical manifestations.
- Prompt recognition and management are crucial for invasive streptococcal infections.
- Continued surveillance for emerging, aggressive bacterial strains is warranted.
Abstract:
Eight cases of invasive group A streptococcal disease in young children were reported over a three-month period, February to April 1990. The spectrum of clinical disease included: pneumonia with bacteremia (two patients), osteomyelitis/septic arthritis (three patients), epiglottitis/supraglottitis (two patients), and sepsis without a focus (one patient). Three cases followed chicken pox. Three children were in shock at the time of presentation, including one child who had a toxic shock-like appearance. Only four children had pharyngitis. Bacteremia was confirmed in three children and presumed in another three. All the subjects survived. Four isolates of group A streptococci were tested for exotoxin A, B, and C (A-0, B-4, C-1) production. These data confirm the reappearance of a highly invasive strain of group A streptococci capable of producing a variety of clinical diseases, including bacteremia and shock, in a significant proportion of victims.