Invasive Group A Streptococcus Infection in Children in Central Israel in 2012–2019

Abstract

Background: Group A Streptococcus can cause serious and sometimes life-threatening disease in children. The past few years have witnessed a rise in invasive group A Streptococcus infection (iGASi) for unclear reasons. This study attempted to describe the epidemiology, the clinical and demographic characteristics and the outcomes associated with iGASi in hospitalized children in central Israel Methods: We retrospectively analyzed the medical records of children <18 years old discharged with a diagnosis of iGASi between January 2012 and December 2019. Clinical, laboratory and microbiologic data, and immunization status were retrieved. The patients were divided into severe and nonsevere groups based on their clinical presentation. The emm type was determined at the national reference center. Results: A total of 167 patients with 206 positive cultures for group A Streptococcus were identified. Hospitalizations for iGASi increased from 701 to 958 per 100,000 admissions between 2012-2015 and 2016-2019, respectively, representing an increase of 37%. The majority of the isolates were from the otolaryngologic system followed by blood, deep soft tissue and respiratory sites. Uncomplicated mastoiditis was the most common diagnosis, followed by bacteremia. Pneumonia was the main diagnosis in the severe group (39.4%). Conclusions:The admissions because of iGASi in children <18 years old increased during the last 8 years. Surveillance systems and prospective studies should be conducted to expend our understanding of the epidemiology of iGASi in children, better assess the pathogenesis and specific risk factors and monitor changes in emm-type distribution.

Clinical, microbiological, and molecular characterization of pediatric invasive infections by Streptococcus pyogenes in Spain in a context of global outbreak

“…The most frequent types in children continued to be emm 1 and emm 12, both in our series and in that of other countries ( 26 ), as well as in many pre-pandemic pediatric cohorts ( 30 ). In our study, emm 89 lacking the has ABC locus was one of the most frequent types observed in mild cases; this emm type, which belongs to clade 3 and emerged in 2008 ( 31 ), has been described as associated with dermal infections ( 4 , 32 ).…”

Enfermedades invasoras por Streptococcus pyogenes en población pediátrica. Caracterización clínico-molecular 2014-2020

“…La susceptibilidad de los lactantes sin enfermedades previas, de presentar tanto EI como sus formas graves, ha sido referida previamente e implica que probablemente la inmunidad del hospedero está involucrada en su fisiopatología 4,13,27 . En esta comunicación los casos clínicos graves se presentaron, en su mayoría, en pacientes bajo 2 años de edad, con una media de edad más baja en relación con las formas menos graves.…”

“…En esta comunicación, el caso fatal sucedió en esta estación. Aunque no están definidos con claridad los mecanismos implicados, se plantea que ciertas proteínas del virus influenza, como la hemaglutinina podrían aumentar la virulencia del microorganismo y/o suprimir la respuesta inmune del hospedero 13,[29][30][31] . Son necesarias futuras investigaciones rigurosas desde el punto de vista metodológico para tratar de definir si la prevención de la infección por influenza podría reducir la EI por S. pyogenes.…”

“…Los casos fueron asignados a 4 grupos de acuerdo con la presentación clínica y al sitio de aislamiento: infección osteoarticular (artritis séptica, osteomielitis y osteoartritis), absceso no cutáneo (incluyendo linfadenitis supurada, flegmón periamigdalino y absceso retrofaríngeo), infección pleuropulmonar (neumonía) y aislamiento en sangre (incluyendo bacteriemia oculta, sepsis, shock séptico o SST) 13 .…”

“…• Bacteriemia oculta se definió por el aislamiento de S. pyogenes en sangre, en un niño febril sin aspecto clínico de toxicidad ni foco clínico evidente [16][17][18] . • Los pacientes que se presentaron con inestabilidad hemodinámica y los que fueron admitidos a UTI por una razón no quirúrgica fueron considerados casos graves 13 .…”