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[Fulmonant group A streptococcal infection accompanied by massive pulmonary hemorrhage and subsequent asphyxia: a
H Nakada1, T Maemoto, K Kitazawa
1Department of Pediatrics, Asahi General Hospital.
Insights
A rare, aggressive group A streptococcal infection caused a fatal outcome in a child despite initial antibiotic treatment. The rapid progression involved severe respiratory distress and pulmonary hemorrhage.
Area of Science:
- Pediatrics
- Infectious Diseases
- Pathology
Background:
- Group A Streptococcus (GAS) is a common bacterial pathogen.
- Fulminant GAS infections, though rare, can lead to severe morbidity and mortality.
Observation:
- A 6-year-old child presented with pharyngalgia and fever, treated with cephalosporin.
- Recurrence of symptoms followed by rapid onset of tachypnea and hemoptysis occurred.
- The patient was declared dead on arrival (DOA) with massive pulmonary hemorrhage.
Findings:
- Autopsy revealed numerous cocci in vessels and extensive pulmonary hemorrhage.
- Streptococcus pyogenes, serotype M4, T4, was isolated from the blood.
- The isolated strain produced exotoxins B and C and was sensitive to penicillins.
Implications:
- This case highlights the potential for rapid, fatal progression of GAS infections.
- Understanding the virulence factors and serotypes of GAS is crucial for early diagnosis and treatment.
- Prompt recognition and aggressive management are critical in suspected fulminant streptococcal disease.
Abstract:
A case of fulminant group A streptococcal infection occurring in a 6-year-old Japanese child is reported. She was accompanied by massive pulmonary hemorrhage and subsequent asphyxia. She initially had pharyngalgia with fever. The cephalosporin antibiotic was given orally for 3 days. Three days after that recurrence of fever and pharyngalgia was noted. Twelve hours later tachypnea and a sudden onset of hemoptysis was noted. She manifested DOA (dead on arrival) and died in the emergency room. Autopsy revealed the presence of numerous cocci in the vessels and massive pulmonary hemorrhage. Streptococcus pyogenes was isolated from the blood. The serotype of this group A streptococcal organism was typed as M4, T4, which produces exotoxin type B and C, which was sensitive to the penicillins.