Emergence of Invasive Group A Streptococcal Disease Among Young Children

Abstract

Eight cases of invasive group A streptococcal disease in young children were reported over a three-month period, February to April 1990. The spectrum of clinical disease included: pneumonia with bacteremia (two patients), osteomyelitis/septic arthritis (three patients), epiglottitis/supraglottitis (two patients), and sepsis without a focus (one patient). Three cases followed chicken pox. Three children were in shock at the time of presentation, including one child who had a toxic shock-like appearance. Only four children had pharyngitis. Bacteremia was confirmed in three children and presumed in another three. All the subjects survived. Four isolates of group A streptococci were tested for exotoxin A, B, and C (A-0, B-4, C-1) production. These data confirm the reappearance of a highly invasive strain of group A streptococci capable of producing a variety of clinical diseases, including bacteremia and shock, in a significant proportion of victims.

Invasive group A streptococcal infections in childhood: Experience in North Yorkshire

“…Our second study of hospitalised patients with invasive GAS infection revealed that bacteraemic cases in children were outnumbered at least two-or three-fold by those who were not proved bacteraemic. The spectrum of clinical conditions associated with invasive GAS in childhood was wide (see Table 3) and generally resembled those reported by others [1,[13][14][15][16][17][18]. Taken together, the range of possible manifestations is very similar to that seen in adults, although certain clinical forms such as varicella-or pharyngitis-associated infection, bone and joint infections and abscess may predominate.…”

“…1) where the illness was modest and fleeting, resembling other forms of childhood doccult bacteraemiaT [26]. We saw no instances of toxic shock syndrome, necrotising soft tissue infection or pneumonia in children, although these forms have been reported by others [1,2,[5][6][7]11,14,16,18,20]. Only one in our series of 24 cases (4%) proved fatal (a 5-month-old diabetic child with very rapid clinical course), a much lower rate than that seen in the adults, but others have reported fatal infections with pneumonia, overwhelming sepsis, necrotising fasciitis and toxic shock syndrome in children [2,7,[10][11][12]14,17,18].…”

“…The pre-school and early school days are a peak time for the acquisition of GAS skin and upper respiratory tract infections (established in reports as the principal sources for invasive infection in childhood) [6,16,[18][19][20], although the great majority of such infections remain simple and superficial. Some acute virus infections, at their peak incidence at this time in childhood (such as varicella and measles), are known to predispose to invasive GAS infection by providing suitable portals for bacterial entry and temporary immune suppression [1,3,[5][6][7]16,19]. Later childhood is a time of vigorous good health, occasionally compromised in a relevant way by sports injuries or the cuts and grazes of an active life, but the degenerative, neoplastic and endocrine disorders that become the frequent setting for invasive GAS infections later in life rarely arise.…”

“…Reported case series and surveys of serious group A streptococcal (GAS) infection [1][2][3][4][5][6][7][8][9][10][11][12][13] have usually included some childhood infections as part of the spectrum encountered, but there have been relatively few studies reporting more specifically on this age group [14][15][16][17][18][19][20]. Over many years we have accumulated a database of local cases of invasive GAS infection in patients of all ages for study.…”

Role of mga in growth phase regulation of virulence genes of the group A streptococcus

“…Severe invasive GAS infections of skin and soft tissues, such as myositis (muscle), cellulitis (dermis), and necrotizing fasciitis (subcutaneous tissue and fascia), can sometimes become life threatening (37,59). Streptococcal toxic shock syndrome, a soft-tissue infection characterized by shock, bacteremia, multiorgan failure, and a 30% mortality rate, has also been reported with increasing frequency in recent years (24,37,59,60). In some cases, GAS infections can lead to serious nonsuppurative sequelae such as rheumatic fever, acute glomerulonephritis, and rheumatic heart disease.…”