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Invasive disease by Streptococcus pyogenes: patients hospitalized for 6 years
Vanessa Arias-Constantí1, Victoria Trenchs-Sainz de la Maza2, Nuria Elvira Sanz-Marcos1
1Servicio de Urgencias de Pediatría, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España.
Insights
Invasive disease (ID) due to Streptococcus pyogenes (Group A Streptococcus, SGA) is rare but serious in children. Skin and soft tissue infections and pneumonia were common, with low mortality despite severe symptoms.
Area of Science:
- Pediatric Infectious Diseases
- Microbiology
- Epidemiology
Background:
- An increase in severe invasive disease (ID) cases caused by Streptococcus pyogenes (Group A Streptococcus, SGA) has been observed.
- SGA infections can lead to severe complications, necessitating a better understanding of their epidemiology and clinical presentation in pediatric populations.
Purpose of the Study:
- To analyze the epidemiology and clinical features of invasive disease (ID) caused by Streptococcus pyogenes (SGA) in a tertiary pediatric hospital.
- To identify common clinical manifestations, risk factors, and outcomes associated with SGA ID in children.
Main Methods:
- Retrospective study of pediatric inpatients diagnosed with ID due to SGA between 2009 and 2014.
- Inclusion criteria required SGA isolation from sterile sites or specific criteria for necrotizing fasciitis or Streptococcal Toxic Shock Syndrome (STSS).
- Data collected included demographics, infection type, risk factors, clinical presentation, treatment, and outcomes.
Main Results:
- Fifty-two cases of SGA ID were identified, with a median age of 3 years. Skin lesions were the most frequent manifestation (40.4%).
- Common infections included skin and soft tissue infections (26.9%), pneumonia (26.9%), and bone/joint infections (23.1%). Streptococcal Toxic Shock Syndrome (STSS) occurred in 19.2% of cases.
- Surgical intervention was needed in 34.6% of cases, and 32.7% required pediatric intensive care. The overall mortality rate was low (1.9%).
Conclusions:
- Invasive disease due to Streptococcus pyogenes (SGA) is an uncommon but severe condition in pediatric hospital admissions.
- Skin and soft tissue infections and pneumonia are the most frequent forms of SGA ID.
- Despite severe clinical presentations, the mortality rate in this pediatric cohort was notably low.
Introduction And Objective:
The last years an increase of severe cases of invasive disease (ID) due to Streptococcus pyogenes or streptococcus b-hemolytic group A (SGA) had been detected. The aim of this study was to analyze the epidemiology and the clinical features of ID due to SGA in a tertiary Pediatric Hospital.
Material And Methods:
Retrospective study in a Pediatric hospital, of all in-patients with final diagnosis of ID due to SGA during 6 years (2009-2014). To consider ID, SGA had to be isolated in sterile samples; in patients with fascitis necroticans in skin samples or in any sample in patients with the diagnostic of Streptococcal Toxic Shock Syndrome (STSS). The SSTS was defined as hypotension and at least 2 of these criteria: renal failure, hepatic failure, acute respiratory distress, tissue necrosis or desquamative erythematous rash. Demographic data, type of infection, risk factors, clinical presentation, analytical data at admission, treatment, need for admission to a pediatric intensive care unit, microbiological data, hospital stay and evolution were collected.
Results:
Fifty-two (52) cases were included (12/10,000 of all inpatients); 3 years-old was the medium age (p25-75: 1.4-6.9 years); 28 (53.8%) were boys. Fourteen patients (26.9%) had risk factors. Fever was the major symptom (51 patients, 98.1%). The skin lesions were the most frequent clinical manifestations found (21; 40.4%). In 50 (96%) cases, SGA was isolated in at least one sterile sample. Skin and soft tissue infections were diagnosed in 14 patients (26.9%), 14 (26.9%) pneumonias, 12 (23.1%) bones and joints infections, 10 (19.2%) SSTS, 6 (11.5%) occult bacteremia, 4 (7.7%) meningitis and 2 (3.8%) sepsis. Surgery was required in 18 cases (34.6%) and 17 patients (32.7%) needed intensive care. The medium hospital stay was 9.5 days (p25-75: 8-15 days). Three patients presented sequels and one patient died.
Conclusion:
The ID due to SGA was a rare but serious reason for hospital admission. Skin and soft tissue infections, and pleuroneumonia were the most common forms of ID. The mortality of our sample was low despite the serious clinical manifestations.
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