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Invasive group A streptococcal infections in children with varicella in Southern California
D J Vugia1, C L Peterson, H B Meyers
1Division of Communicable Disease Control, California Department of Health Services, Berkeley 94704, USA.
Insights
Invasive group A streptococcal (GAS) infections are a serious complication of varicella in children. Early recognition and treatment are crucial, and varicella vaccination may reduce these severe GAS infections.
Area of Science:
- Pediatric Infectious Diseases
- Bacteriology
- Epidemiology
Background:
- Varicella (chickenpox) can be complicated by invasive group A streptococcal (GAS) infections.
- Prompt identification and management of these co-infections are critical for patient outcomes.
Purpose of the Study:
- To characterize the demographic and clinical features of invasive GAS infections occurring in children with varicella.
- To inform clinical awareness and potential prevention strategies.
Main Methods:
- Retrospective review of medical records for children diagnosed with invasive GAS infections following varicella.
- Infection identification by hospital infection control nurses in Los Angeles and Orange Counties, California.
- Analysis of clinical data, GAS isolate characteristics, and patient outcomes.
Main Results:
- Twenty-four pediatric cases of invasive GAS infection post-varicella were identified.
- Common presentations included cellulitis, myositis/necrotizing fasciitis, pneumonia, and bacteremia.
- Five patients exhibited multiorgan involvement, including two with streptococcal toxic shock-like syndrome.
Conclusions:
- Invasive GAS disease is a severe complication of varicella, necessitating clinical vigilance.
- Physicians should suspect GAS infection in children with varicella who develop fever and localized swelling or cellulitis.
- Widespread varicella vaccination could potentially decrease the incidence of invasive GAS infections in this context.
Objective:
To describe demographic and clinical features of invasive group A streptococcal (GAS) infections in children with varicella in Southern California in early 1994.
Methods:
From hospitals of Los Angeles and Orange Counties, children with invasive GAS infections after varicella between January 1 and April 8, 1994, were identified by hospital infection control nurses. Medical records of patients were reviewed, and any available GAS isolate was further tested.
Results:
Twenty-four cases were identified; 54% were male, 50% were Hispanic and the median age was 3 years (range, 0.5 to 8). Four cases died before hospitalization. The other 20 were hospitalized for a median of 10 days (range, 4 to 50): 14 presented with cellulitis (1 with concomitant epiglottitis), 2 with myositis/necrotizing fasciitis, 2 with pneumonia and 2 with bacteremia without apparent source. Five had evidence of multiorgan involvement including two patients fulfilling criteria of streptococcal toxic shock-like syndrome. Of 19 patients with blood cultures, 10 (53%) had GAS bacteremia. Onset of GAS infection was suggested, as a median, on Day 4 of varicella, with fever, vomiting and localized swelling being commonly reported. The mean maximum temperature on the day of admission was 39.4 degrees C (102.9 degrees F). Four GAS isolates were M1T1 and one was M3T3. Five isolates produced streptococcal pyrogenic exotoxins A and B.
Conclusions:
Invasive GAS disease, including streptococcal toxic shock-like syndrome, is a serious complication of varicella. Physicians should be alert for the complication of GAS when fever and localized swelling or signs of cellulitis develop 3 days or more after the onset of varicella. Widespread use of varicella vaccine may decrease invasive GAS infections in this setting.