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Group A streptococcal necrotizing fasciitis following varicella in children: case reports and review
G J Wilson1, D F Talkington, W Gruber
1Department of Pediatrics, Vanderbilt Medical School, Nashville, Tennessee 37232, USA.
Abstract:
We report four cases of necrotizing fasciitis that occurred following varicella in children ranging in age from 2 to 8 years. The only organism isolated from each of these patients was Streptococcus pyogenes or group A beta-hemolytic Streptococcus (GABHS). Each child recovered; however, three required repeated surgical debridements in addition to therapy with antibiotics. An interesting finding in these patients was the development of hyponatremia and/or hypocalcemia. M-typing and T-typing of the isolates demonstrated that the GABHS strain in two children who attended the same school was M5; M1 and M3 strains were identified in the other two children. In addition to the children described in this series, eleven other cases of children with necrotizing fasciitis following varicella have been reported in the English-language literature since 1970. We believe that these cases provide further evidence that varicella is an important risk factor for necrotizing fasciitis that is caused by more-virulent strains of GABHS.
Insights
Necrotizing fasciitis in children can occur after varicella (chickenpox). This severe bacterial infection, caused by Streptococcus pyogenes, requires prompt treatment and can lead to complications like electrolyte imbalances.
Area of Science:
- Pediatric Infectious Diseases
- Dermatology
- Microbiology
Background:
- Necrotizing fasciitis is a severe bacterial infection that can lead to rapid tissue destruction.
- Varicella (chickenpox) is a common childhood viral illness.
- The association between varicella and Streptococcus pyogenes (group A beta-hemolytic Streptococcus, GABHS) induced necrotizing fasciitis in children is rare but serious.
Observation:
- Four pediatric cases of necrotizing fasciitis following varicella infection are presented.
- All isolates were identified as Streptococcus pyogenes (GABHS).
- Patients experienced hyponatremia and/or hypocalcemia, alongside the need for surgical debridements and antibiotic therapy.
Findings:
- The study identified specific M-types (M5, M1, M3) of GABHS strains involved in these pediatric cases.
- Two children with the M5 strain attended the same school, suggesting potential transmission.
- This series adds to the eleven previously reported cases since 1970, reinforcing the link.
Implications:
- Varicella infection appears to be a significant risk factor for developing necrotizing fasciitis caused by virulent GABHS strains in children.
- Early recognition and aggressive management, including surgical intervention and antibiotics, are crucial for patient recovery.
- Further research into GABHS virulence factors and host susceptibility post-varicella is warranted.