Fatal Pediatric Streptococcal Infection: A Clinico-Pathological Study

Area of Science:

• Pediatric Pathology
• Infectious Diseases
• Forensic Medicine

Background:

• Streptococcal infections (SI) are a significant cause of pediatric mortality.
• Autopsy findings in fatal SI cases are not extensively documented.
• Understanding autopsy findings is crucial for accurate diagnosis and public health.

Purpose of the Study:

• To analyze autopsy findings in fatal pediatric streptococcal infections.
• To identify common pathogens and clinical presentations in fatal SI.
• To investigate the challenges in postmortem diagnosis of sepsis.

Main Methods:

• Retrospective review of pediatric SI cases (1997-2019) without pre-existing risk factors.
• Analysis of clinical and pathological findings from autopsy reports.
• Bacterial culture results were used for pathogen identification.

Main Results:

• Streptococcus pneumoniae (SPn; 45%) and Streptococcus pyogenes (SPy; 37%) were the most common causative agents.
• 89% of cases had a rapid clinical course, with death within 24 hours of admission.
• Sepsis was identified in 64% of deaths, more common in SPy than SPn cases. Pneumonia was common; meningitis was exclusive to SPn.

Conclusions:

• Fatal SI in children is primarily caused by SPn or SPy, often presenting with prodromal symptoms and rapid progression.
• Sepsis is a frequent complication, with varying prevalence between SPn and SPy.
• Accurate postmortem diagnosis of sepsis requires correlation of clinical data, cultures, and autopsy findings.