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Streptococcal toxic shock syndrome complicating varicella in children
1Department of Pediatrics, National Cheng Kung University Medical Center, Tainan, Taiwan.
Insights
Group A beta-hemolytic streptococci can cause severe infections in children with varicella (chickenpox). This case highlights the risk of streptococcal toxic shock syndrome, a life-threatening condition, following a varicella infection.
Area of Science:
- Pediatrics
- Infectious Diseases
- Dermatology
Background:
- Cutaneous superimposed infections with pyogenic bacteria are common complications of varicella (chickenpox) in children.
- Group A beta-hemolytic streptococci (GABHS) are frequently implicated pathogens, capable of causing severe, life-threatening infections.
- Streptococcal toxic shock syndrome (STSS) is a newly recognized, severe illness associated with high morbidity and mortality.
Observation:
- A 3-year-old boy with varicella developed symptoms of STSS, including fever, vomiting, and lethargy.
- The patient's condition rapidly deteriorated despite aggressive medical interventions, including fluid resuscitation, inotropic agents, and cardiopulmonary resuscitation.
- The child died within 4 hours of hospitalization.
Findings:
- This case represents the first reported instance of streptococcal toxic shock syndrome associated with varicella in Taiwan.
- The findings underscore the potential for GABHS to cause severe complications in children with varicella.
- Pediatricians must maintain a high index of suspicion for GABHS infections in children presenting with varicella.
Implications:
- Early recognition and prompt management of GABHS infections are crucial for improving outcomes in children with varicella.
- This case emphasizes the importance of considering severe bacterial superinfections in the differential diagnosis of children with varicella, especially those presenting with systemic symptoms.
- Further research may be warranted to elucidate the specific mechanisms and risk factors contributing to STSS following varicella infection.
Abstract:
The most common complication in children with varicella is cutaneous superimposed infection with pyogenic bacteria. Group A beta-hemolytic streptococci, which are known to cause life-threatening infections in both previously healthy children and those with underlying diseases, are the most frequently associated pathogens. A newly recognized disease, called streptococcal toxic shock syndrome, is associated with severe morbidity and mortality. We report a 3-year-old boy with a diagnosis of this syndrome who presented with increasing fever, vomiting, and lethargy 7 days after the development of a classic varicella skin lesion. In spite of aggressive fluid supply, administration of inotropic agents, and cardiopulmonary resuscitation, a rapidly deteriorating clinical course led to death 4 hours after hospitalization. This is the first report of this association in Taiwan. Pediatricians evaluating children with varicella must be mindful of the potential for Group A beta-hemolytic streptococcal infection.