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Multisystem group A beta-hemolytic streptococcal disease in children
M A Jackson1, V F Burry, L C Olson
1Department of Pediatrics, University of Missouri-Kansas City School of Medicine.
Insights
Severe streptococcal infections in children can cause multisystem dysfunction, affecting the brain, kidneys, and liver. Early recognition is crucial for prompt treatment of this serious condition.
Area of Science:
- Pediatric Infectious Diseases
- Toxicology
- Critical Care Medicine
Background:
- Streptococcal infections can lead to severe, multisystem complications in children.
- Multisystem dysfunction presents a diagnostic challenge due to diverse clinical manifestations.
Observation:
- Eight children (3-11 years) presented with severe streptococcal infection and toxic condition.
- Prominent symptoms included encephalopathy, severe hyperesthesia, rash, hyponatremia, musculoskeletal complaints, renal, and hepatic involvement.
- Five patients required fluid resuscitation; three needed surgical intervention for occult infections.
Findings:
- All patients exhibited renal involvement and hyponatremia.
- Encephalopathic symptoms were observed, with mild pleocytosis in cerebrospinal fluid in two cases.
- Hepatopathy was present in four of five patients, characterized by hyperbilirubinemia and elevated liver enzymes.
Implications:
- A high index of suspicion is essential for diagnosing severe streptococcal infections in children.
- Prompt recognition and initiation of appropriate therapy are critical for managing multisystem dysfunction.
- Understanding the varied clinical presentations aids in timely and effective pediatric critical care.
Abstract:
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.