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Streptococcus pyogenes Endocarditis Associated With Varicella-Case Report and Review of the Literature

Patrizia Savoia1, Ulrich Heininger2, Michael Buettcher3

  • 1Paediatric Intensive Care and Neonatology, Lucerne Children's Hospital, Cantonal Hospital Lucerne, Lucerne, Switzerland.

Frontiers in Pediatrics
|December 24, 2019
PubMed

Insights

Varicella zoster virus (VZV) infection can lead to serious Streptococcus pyogenes (Group A Streptococcus) endocarditis in children, a rare but potentially fatal condition. This case highlights a unique instance requiring cardiac surgery due to valve rupture.

Area of Science:

  • Pediatric Infectious Diseases
  • Cardiology
  • Microbiology

Background:

  • Varicella zoster virus (VZV) infection is typically benign but can predispose to severe bacterial complications.
  • Streptococcus pyogenes (Group A Streptococcus, GAS) is a significant pathogen causing serious infections, including endocarditis.
  • Pediatric infective endocarditis (IE) caused by GAS is rare, with limited reported cases.

Observation:

  • A rare pediatric case of infective endocarditis caused by Streptococcus pyogenes following varicella zoster virus infection is presented.
  • This case involved acute deterioration due to mitral valve chordae tendineae rupture, necessitating cardiac surgery, a complication not previously reported.
  • Literature review identified only 18 pediatric GAS endocarditis cases since 1942, with VZV as a preceding illness in 28%.

Findings:

  • GAS endocarditis in children is uncommon, with most cases lacking pre-existing cardiac abnormalities (78%).
  • Mortality remains a concern, with a reported death rate of 17% in pediatric GAS endocarditis.
  • The presented case represents a unique severe presentation of GAS endocarditis with acute valvular damage.

Implications:

  • This case underscores the importance of recognizing severe bacterial complications, like GAS endocarditis, secondary to VZV infections in children.
  • Early diagnosis and aggressive management, including surgical intervention for valve rupture, are crucial for improving outcomes in pediatric GAS endocarditis.
  • Further research is warranted to understand the pathogenesis and optimize treatment strategies for this rare but severe pediatric condition.
Keywords:
Streptococcus pyogenesinfective endocarditismitral valvenecrotizing fasciitisvaccinationvaricella

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