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[Invasive streptococcal infection as a complication of chickenpox]
S P Geelen1, E R de Graeff-Meeder
1Wilhelmina Kinderziekenhuis, afd. Algemene Pediatrie/Infectieziekten, Utrecht.
Insights
Group A streptococcal (GAS) infections can be severe complications during chickenpox (varicella). Early recognition of GAS invasive disease during varicella is crucial for prompt treatment and improved outcomes.
Area of Science:
- Pediatrics
- Infectious Diseases
- Bacteriology
Background:
- Varicella (chickenpox) is a common childhood viral infection.
- Invasive bacterial infections can occur as complications of viral illnesses.
- Group A Streptococcus (GAS) is a significant bacterial pathogen.
Observation:
- Two pediatric patients presented with invasive GAS infections during primary varicella.
- An infant developed severe cellulitis, bacteremia, and osteomyelitis.
- An older child exhibited symptoms consistent with GAS-associated toxic shock syndrome, including fever, hypotension, and respiratory distress.
Findings:
- Invasive GAS infections, including osteomyelitis and toxic shock syndrome, can complicate primary varicella.
- Bacterial superinfections should be suspected in children with varicella experiencing persistent or secondary fever, or extremity pain.
- GAS and Staphylococcus aureus are potential causative agents, even without apparent skin lesions.
Implications:
- Clinicians should maintain a high index of suspicion for invasive GAS infections in children with varicella presenting with specific warning signs.
- Prompt diagnosis and initiation of antibiotic therapy are critical for managing severe GAS complications.
- Understanding the link between varicella and invasive bacterial infections can guide clinical management and public health strategies.
Abstract:
Two girls aged 11 months and 6 years, presented with an invasive group A streptococcal (GAS) infection during the course of primary varicella. The infant had severe cellulitis of the left arm and leg, fever and bacteraemia. She developed osteomyelitis of ulna and tibia. The 6-year-old girl had a fever > 38.5 degrees C, hypotension, an acute respiratory distress syndrome, liver function abnormalities, and positive cultures of blood and joints. Her clinical picture was compatible with a GAS-associated toxic shock syndrome. If during the course of primary varicella persistent fever, secondary fever or pain in one or more extremities occurs, invasive bacterial infection by GAS or Staphylococcus aureus should be considered, even in the absence of skin infection or cellulitis.