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When should clinicians suspect group A streptococcus empyema in children? A multicentre case-control study in French
Sophia Bellulo1, Julie Sommet2, Corinne Lévy3
1Department of Pediatrics, CHU Nord, Marseille, France.
Insights
Invasive group A Streptococcus (GAS) empyema in children is increasing and presents with distinct symptoms like rash and circulatory failure. Early recognition of these signs is crucial for timely and effective treatment, potentially including antitoxin drugs.
Area of Science:
- Pediatrics
- Infectious Diseases
- Critical Care Medicine
Background:
- Global rise in invasive group A Streptococcus (GAS) infections contrasts with declining pneumococcal disease.
- Limited data exists on GAS pleural empyema in pediatric populations.
Purpose of the Study:
- To characterize clinical and microbiological aspects of GAS pleural empyema in children.
- To compare GAS empyema with pneumococcal empyema in terms of presentation, management, and outcomes.
Main Methods:
- A descriptive study matched 50 children with GAS empyema to 50 with pneumococcal empyema.
- Data collected from January 2006 to May 2013 across 8 hospitals in a national pneumonia survey.
Main Results:
- GAS empyema cases (median age 2 years) frequently presented with rash (74%), circulatory failure (74%), and respiratory distress.
- GAS empyema patients showed higher rates of ICU admission, drainage procedures, and complications compared to pneumococcal empyema.
- Mortality was 4% in the GAS empyema group.
Conclusions:
- Rash, circulatory failure, and leukopenia in pediatric empyema may indicate GAS infection.
- Prompt initiation of antitoxin therapy, such as clindamycin, is recommended for suspected GAS empyema.
Background:
The incidence of invasive group A streptococcus (GAS) infections is increasing worldwide, whereas there has been a dramatic decrease in pneumococcal invasive diseases. Few data describing GAS pleural empyema in children are available.
Objective:
To describe the clinical and microbiological features, management and outcome of GAS pleural empyema in children and compare them with those of pneumococcal empyema.
Design, Setting And Patients:
Fifty children admitted for GAS pleural empyema between January 2006 and May 2013 to 8 hospitals participating in a national pneumonia survey were included in a descriptive study and matched by age and centre with 50 children with pneumococcal empyema.
Results:
The median age of the children with GAS pleural empyema was 2 (range 0.1-7.6) years. Eighteen children (36%) had at least one risk factor for invasive GAS infection (corticosteroid use and/or current varicella). On admission, 37 patients (74%) had signs of circulatory failure, and 31 (62%) had a rash. GAS was isolated from 49/50 pleural fluid samples and from one blood culture. The commonest GAS genotype was emm1 (n=17/22). Two children died (4%). Children with GAS empyema presented more frequently with a rash (p<0.01), signs of circulatory failure (p=0.01) and respiratory disorders (p=0.02) and with low leucocyte levels (p=0.04) than children with pneumococcal empyema. Intensive care unit admissions (p<0.01), drainage procedures (p=0.04) and short-term complications (p=0.01) were also more frequent in patients with GAS empyema.
Conclusions:
Pleural empyema following varicella or presenting with rash, signs of circulatory failure and leucopenia may be due to GAS. These features should prompt the addition to treatment of an antitoxin drug, such as clindamycin.
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