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[Streptococcus pyogenes infection in paediatrics: from pharyngotonsillitis to invasive infections]
David Espadas Maciá1, Eva María Flor Macián1, Rafael Borrás2
1Unidad de Cuidados Intensivos de Pediatría, Hospital Clínico Universitario de Valencia, Valencia, España.
Insights
Group A Streptococcus infections are common in children, with an increasing incidence of invasive Group A Streptococcus infections in those under 5 years old. Invasive infections are most severe in younger children, but no deaths occurred.
Area of Science:
- Pediatric Infectious Diseases
- Bacteriology
- Epidemiology
Background:
- Group A Streptococcus (GAS) infections are prevalent in infants.
- Recent years have seen a rise in invasive GAS (iGAS) infections.
Purpose of the Study:
- To analyze the epidemiology and clinical characteristics of GAS infections in children.
- To investigate trends in invasive GAS infections and their outcomes.
Main Methods:
- Retrospective-descriptive study of children under 15 with GAS infections from 2004-2014.
- Analysis of culture data, patient demographics, clinical presentations, and treatment outcomes.
Main Results:
- 2,192 GAS cultures, predominantly pharyngeal.
- 29 hospital admissions: 14 iGAS cases, 4 probable iGAS, 4 suppurative, 7 post-infective complications.
- iGAS incidence was 2.1/100,000 children/year, more common in younger children without seasonality.
- Pneumonia was the most frequent iGAS diagnosis; 8 patients required intensive care.
- All GAS isolates were penicillin-susceptible; 10.6% erythromycin resistance.
- No patient deaths reported.
Conclusions:
- Group A Streptococcus pharyngotonsillitis is common in childhood, with increasing incidence in children under 5.
- Invasive GAS infections represent severe presentations, predominantly affecting younger children.
- Post-infectious complications are currently rare.
Background:
Streptococcus pyogenes or Group A Streptococci (GAS) cause many infections in infancy. Changes in its epidemiology have been described in recent years, including an increase in invasive infections (iGAS).
Methods:
A retrospective-descriptive study was conducted on children less than 15 years old, with GAS infections, in particular iGAS, and their complications from February 2004-April 2014.
Results:
A total of 2,192 positive cultures were obtained of which 92.7% were pharyngeal cultures. Twenty-nine patients were admitted to hospital: 4 with suppurative complications, 7 post-infective, 14 iGAS, and 4 probable iGAS cases. There were no differences in the frequency of GAS isolations/year. Non-invasive isolates were more frequent in winter and spring (P<.001), and 68.3% were in patients younger than 5 years. The incidence of iGAS was 2.1/100,000 children/year. There was no seasonality, and it was more frequent in younger children (P=.039). The most common diagnosis was pneumonia (6/14). Eight patients required intensive care. They were treated empirically with second or third-generation cephalosporin or with intravenous penicillin, and pneumonia required longer treatment times (P=.016). All GAS isolates were sensitive to penicillin, and 10.6% were resistant to erythromycin. The time spent in hospital was longer for iGAS than other cases (P=.028). No patients died.
Conclusions:
Pharyngotonsillitis caused by GAS is common in childhood, and its incidence is increasing in children younger than 5 years. At the moment, post-infectious complications are rare. Invasive infections are the most severe forms of presentation, and are more common in younger children.