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Group A Streptococcal Disease in Sudden Unexpected Death in Youth in the Pre- and Post-COVID-19 Era

Evelien B van Kempen1,2, Annelotte M Pries1, Emmeline P Buddingh3

  • 1From the Department of Paediatrics, ErasmusMC Sophia Children's Hospital, Rotterdam, the Netherlands.

The Pediatric Infectious Disease Journal
|March 10, 2025
PubMed

Insights

Invasive group A streptococcal infections (iGAS) are a significant cause of sudden unexplained deaths in youth (SUDY). Children with co-infections like varicella or influenza face a higher risk of severe iGAS outcomes.

Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Epidemiology

Background:

  • An increase in pediatric invasive group A streptococcal (iGAS) infections and related deaths has been noted in the Netherlands.
  • Sudden unexplained deaths in youth (SUDY) are investigated using the Postmortem Evaluation of Sudden Unexplained Death in Youth (PESUDY) protocol.
  • This study compares epidemiological factors of iGAS-related sudden deaths (iGAS-PESUDY) with surviving iGAS cases.

Purpose of the Study:

  • To investigate epidemiological differences between pediatric iGAS-related sudden deaths and surviving iGAS cases.
  • To identify risk factors associated with iGAS-related mortality in children.
  • To understand the clinical presentation and outcomes of iGAS infections in pediatric SUDY cases.

Main Methods:

  • An observational study utilizing data from the COPP-iGAS study and the PESUDY database.
  • Inclusion of pediatric cases (0-18 years) diagnosed with iGAS between August 2016 and December 2022.
  • Comparison of demographic, clinical, and laboratory data between iGAS-PESUDY cases and iGAS survivors.

Main Results:

  • Twenty-one iGAS-PESUDY cases and 156 iGAS survivors were analyzed.
  • iGAS-PESUDY cases were generally older than survivors and showed a significant increase in 2022.
  • Pre-existing or concurrent infections, particularly varicella zoster and influenza, were more common in iGAS-PESUDY cases (66%) than survivors (16%).
  • Lower C-reactive protein levels were observed in iGAS-PESUDY cases compared to survivors.

Conclusions:

  • Invasive group A streptococcal infection is a notable cause of SUDY in children.
  • Lower C-reactive protein levels in iGAS-PESUDY cases may indicate a rapid, fulminant disease course.
  • Co-infections with varicella zoster or influenza viruses appear to increase the risk of mortality from iGAS infections in pediatric populations.
Abstract

Keywords:
epidemiologygroup A streptococcussudden death

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