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Group C beta-hemolytic streptococcal infections in children: nine pediatric cases and review
M Arditi1, S T Shulman, A T Davis
1Department of Pediatrics, Northwestern University Medical School, Chicago, Illinois.
Insights
Group C streptococci can cause serious pediatric infections, including meningitis and sepsis. Penicillin G is the recommended treatment, but susceptibility testing is crucial due to potential tolerance.
Area of Science:
- Microbiology
- Pediatric Infectious Diseases
Background:
- Lancefield group C streptococci are common colonizers but rarely cause invasive disease.
- Pediatric invasive infections due to group C streptococci are infrequently reported.
Observation:
- A retrospective review identified eight pediatric cases of group C streptococcal infection over six years.
- An additional case of meningitis from 1975 and 22 literature cases were analyzed.
- Clinical presentations included pneumonitis, sinusitis, septicemia, endocarditis, osteomyelitis, and meningitis.
Findings:
- Group C streptococci can cause severe, potentially fatal infections in children.
- Biochemical properties and animal infections are discussed.
- Recognition of non-group A beta-hemolytic streptococci is increasing.
Implications:
- Penicillin G is the primary antimicrobial agent for group C streptococcal infections.
- Minimum inhibitory and bactericidal concentrations should be determined due to potential penicillin tolerance.
- Increased recognition of these pathogens may lead to earlier diagnosis and treatment.
Abstract:
Streptococci of Lancefield group C colonize healthy individuals but infrequently cause invasive disease. Eight pediatric cases of infection due to group C streptococci were identified in a retrospective survey of a recent 6-year period at a children's hospital. An additional case of group C meningitis diagnosed in 1975 was included. These nine cases and 22 pediatric cases from the literature are presented to illustrate important points with respect to clinical presentations and complications and to show that these organisms can cause serious, sometimes fatal infection: pneumonitis, sinusitis, septicemia, endocarditis, osteomyelitis, and meningitis. Group C streptococci are described in terms of their biochemical properties, the infections they cause in animals, and their tendency to produce disease in humans. With increasingly frequent serologic grouping of non-group A beta-hemolytic streptococci, recognition of the role of specific non-group A streptococci is likely to increase. The antimicrobial agent of choice for infections due to group C streptococci is penicillin G. The minimum inhibitory and minimum bactericidal concentrations for the organism should be determined since penicillin tolerance may occur and may be responsible for the slow response to penicillin therapy in some cases.