Group A Streptococcus invasive infection in children: Epidemiologic changes and implications

Abstract

Group A Streptococcus (GAS) can cause a broad array of clinical manifestations and complications. Recently, in post COVID-19 postpandemic months, there has been an increased incidence and severity of invasive infections in the pediatric age group in Spain and other European countries with high morbidity, affecting mostly to young children, associated with seasonal peaks in incidence of viral respiratory pathogens. The increased in incidence and severity has not been associated with predominant GAS strains, but rather to the lack of immunity to both GAS and common viral respiratory infections due to isolation measures to prevent COVID-19. Due to the nonspecific initial clinical manifestations a high index of suspicion is necessary in order to initiate a prompt medical and surgical treatment when necessary to improve the outcome. Prevention strategies are needed as well as continuous microbiological surveillance of iGAS strains.

Molecular epidemiology of invasive Group A Streptococcal infections before and after the COVID-19 pandemic in Switzerland

“…Our findings point out that the recent upsurge does not arise from pathogen-related factors, prompting further exploration of alternative causes, as proposed in prior studies [6,9,10,44].…”

Group A Streptococcal Infections in Pediatric Age: Updates about a Re-Emerging Pathogen

“…The upsurge in incidence appears unrelated to any predominant GAS strain but rather correlates with this "immune debt" following reduced exposure to both GAS and common viral respiratory infections [20]. The recrudescence of predisposing viral infections after COVID-19 has increased the prevalence of iGAS infections; most reported cases are superinfections of viral respiratory infections [18,21].…”

“…Invasive GAS infections may be non-specific at the onset and may rapidly progress. Consequently, a high index of suspicion is essential to diagnose and treat the disease appropriately [20]. Antibiotic therapy remains the cornerstone of treatment in invasive infections, with the recommendation to initiate with a broad-spectrum antibiotic, subsequently modifiable once culture results are available.…”

“…In case of penicillin allergy, macrolides are not recommended, and vancomycin is the preferred choice. The addition of an antitoxin antibiotic such as clindamycin or linezolid is recommended, especially in cases of necrotizing fasciitis and streptococcal toxic shock syndrome [20].…”