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Group A streptococcal supraglottitis.

J Lacroix, G Ahronheim, P Arcand

    The Journal of Pediatrics
    |July 1, 1986
    PubMed
    Summary
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    Severe supraglottic infections in children can be caused by group A beta-hemolytic streptococci, mimicking Hemophilus influenzae epiglottitis. These infections may present with prolonged fever and require extended intubation despite antibiotic treatment.

    Area of Science:

    • Pediatric Infectious Diseases
    • Bacteriology
    • Otolaryngology

    Background:

    • Supraglottic infections in children often mimic epiglottitis, with Hemophilus influenzae historically being a common pathogen.
    • Accurate and timely diagnosis is crucial for effective management of pediatric airway infections.

    Observation:

    • Four children presented with severe supraglottic infections clinically suggestive of Hemophilus influenzae epiglottitis.
    • While epiglottic involvement was minimal in most cases, significant aryepiglottic fold inflammation was consistently observed.

    Findings:

    • Group A beta-hemolytic streptococcus was identified as the causative agent in all four patients.
    • Bacteremia was present in two children, and the pathogen was isolated from the supraglottic area and trachea in two others.

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  • Patients experienced prolonged fever (6-22 days) and required extended tracheal intubation (2-16 days) despite appropriate antibiotic therapy.

    • Implications:

    • Group A beta-hemolytic streptococcus should be considered in the differential diagnosis of severe pediatric supraglottic infections, even when clinical presentation suggests H. influenzae.
    • The protracted course and potential for prolonged intubation highlight the need for careful monitoring and management of streptococcal supraglottitis.
    • This underscores the importance of microbiological investigations to guide appropriate antimicrobial therapy in severe pediatric airway infections.