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Invasive disease due to group A beta-hemolytic streptococci: continued occurrence in children in North Carolina
1Department of Pediatrics, Bowman Gray School of Medicine, Wake Forest University, and Brenner Children's Hospital, Winston-Salem, NC 27157, USA.
Insights
Invasive group A beta-hemolytic streptococci (GABS) disease in children continues to rise, with varied presentations and M-types. Varicella coinfection is increasingly common, suggesting a potential role for the varicella vaccine in prevention.
Area of Science:
- Pediatric Infectious Diseases
- Bacteriology
- Epidemiology
Background:
- A previous report noted a rise in invasive group A beta-hemolytic streptococci (GABS) in children during the late 1980s.
- This study aimed to track subsequent epidemiological trends of GABS infections in pediatric patients.
Observation:
- A prospective monitoring of invasive GABS disease was conducted from July 1990 to December 1995.
- Twenty-five pediatric cases were identified with diverse clinical presentations, including necrotizing fasciitis, toxic shock-like syndrome, and sepsis with meningitis.
Findings:
- The incidence of invasive GABS disease in children persisted through the first half of the 1990s.
- A significant increase in GABS infections associated with varicella was observed (28% vs. 5% in prior period).
- Commonly isolated serotypes included M1, M3, M12, M22, and M-nontypeable strains.
Implications:
- The resurgence of invasive GABS disease in children continues, characterized by varied clinical manifestations and serotypes.
- The strong association with varicella suggests that widespread varicella vaccination could potentially reduce invasive GABS incidence.
Background:
We have previously reported a significant increase beginning in the late 1980s in the incidence of invasive disease due to group A beta-hemolytic streptococci (GABS) in children admitted to our hospital. To determine subsequent trends in epidemiology, we have continued to monitor cases.
Methods:
We prospectively monitored cases of invasive disease due to GABS at Brenner Children's Hospital during the 5 1/2 years (July 1, 1990, to December 31, 1995) since our last report.
Results:
Twenty-five patients had GABS isolated from normally sterile sites. Their presentations were varied. One patient had necrotizing fasciitis and one had toxic shock-like syndrome. The one death was that of a newborn infant with sepsis and meningitis. The proportion of GABS infections associated with varicella was significantly greater during this period (7/25, 28%) than during the period 1983 to 1990 (1/22, 5%). Isolates were available tor study from 24 patients. Serotypes were M1 (4), M3 (4), M6 (2), M12 (3), M22 (3), M75 (1) and M-nontypeable (7). The number of cases of invasive disease seen annually from 1983 through 1995 also is reviewed.
Conclusions:
The resurgence of invasive disease due to GABS in children noted in the late 1980s continues through the first half of the 1990s. The clinical manifestations are varied as are the causative M-types. As almost one third of cases in this series were associated with varicella infection, widespread use of the varicella vaccine may lead to a decrease in the incidence of invasive GABS disease.