Multisystem group A beta-hemolytic streptococcal disease in children

Eight children (median age, 8 years; range, 3-11 years) with severe streptococcal infection and multisystem dysfunction are described. All were febrile and in a toxic condition at presentation, and five (62%) of eight required fluid resuscitation. Encephalopathic symptoms were prominent, and two of three examinations of cerebrospinal fluid revealed mild pleocytosis. Severe hyperesthesia with or without an erythematous rash occurred in four (50%) of eight patients. Hyponatremia had occurred in all patients. Musculoskeletal complaints were noted in seven (87%) of eight patients. Three had synovitis and three had soft tissue infection. Renal involvement was noted in all patients, and hepatopathy characterized by mild hyperbilirubinemia and elevated levels of liver transaminase was found in four of five patients. Prolonged fever was noted in children with occult infection and debridement or drainage procedures of the foci were required in three of five affected children. Given the diversity of clinical manifestations, a high index of suspicion is necessary if these patients are to be recognized and appropriate therapy initiated.