Invasive infections by group A Streptococcus infections in Brazil: a pediatric case series

Group A Streptococcus (GAS) are Gram-positive cocci that colonize the nasopharynx and/or skin and in rare cases may cause severe invasive infections. Although these infections decreased during the COVID-19 pandemic, some countries have observed an increased number of invasive GAS (iGAS) diseases in recent years. The objective of this study was to describe a series of iGAS diseases in a referral hospital for the treatment of pediatric infectious disease in Minas Gerais State, Brazil, between September 2022 and August 2023. The data were obtained from medical records, and GAS was isolated from blood, pleural, cerebrospinal, or joint fluid.

A total of nine patients, four male and five female, between eight months and ten years of age, were admitted. Of the patients observed, three (33%) had pneumonia, three (33%) had toxic shock syndrome, three (33%) had septic arthritis, one (11%) had osteomyelitis, two (22%) had meningitis, and two (22%) cellulitis. The majority of patients (5) experienced complications, including pleural effusion, septic shock, cerebral vasculitis, and limb amputations. In total, seven (75%) patients were admitted to the intensive care unit, and one patient died.

It is important to be aware of the possibility of S. pyogenes infection in children with pulmonary, neurological, osteoarticular, skin infections or in severe cases of septic shock. Given the absence of specific clinical signs, epidemiological data showing an increase in the local incidence of S. pyogenes infections is of great importance and should serve as an alert for the diagnosis of the disease.