Serious Group A β-Hemolytic Streptococcal Infections Complicating Varicella

Lesson of the Week: Potentially lethal bacterial infection associated with varicella zoster virus

“…Systemic sepsis with group a streptococcus, complicating chickenpox, is increasingly recognised,4 13 14 15 16 17 18 19 20 21 and this organism was isolated from four children in our series. These children may present with streptococcal toxic shock syndrome,15 22 necrotising fasciitis,14 osteomyelitis,23 pyomyositis,24 gangrene,25 subgaleal abscess,26 arthritis,27 or meningitis28 associated with varicella.…”

“…These children may present with streptococcal toxic shock syndrome,15 22 necrotising fasciitis,14 osteomyelitis,23 pyomyositis,24 gangrene,25 subgaleal abscess,26 arthritis,27 or meningitis28 associated with varicella. Christie et al examined the medical records of 60 children presenting to two centres in the United States with bacteraemia caused by group A streptococcus 29.…”

“…Laboratory findings may include a low platelet count, raised transaminase activity, increased plasma urea and creatinine concentrations, electrolyte disturbance, and coagulopathy 31. Both group A streptococcal disease and staphylococcal infection may present as toxic shock syndrome 11 12 15 22 32 33. Eight of our patients presented with features of toxic shock syndrome and in three of these children enterotoxin producing strains of S aureus were isolated.…”

Potentially preventable infant and child deaths identified at autopsy; findings and implications

“…This is a well-recognized complication of Varicella [13], and suspicion should be raised in cases of children attending primary care who are disproportionately unwell with otherwise typical signs of Varicella infection. Such examples represent potentially missed opportunities to treat a rare but well-reported life-threatening condition.…”

Diagnosis and treatment of invasive group A streptococcal infections

“…It may be that pox lesions act as a portal of entry to the dermal and fascial layers, or that varicella infection itself causes immuno suppression, particularly a decrease in humoral immunity [51] . The latter explanation is supported by the fact that patients tend not to have secondarily infected pox lesions overlying the area of NF [52] , and because STSS and invasive GAS disease without NF may also follow varicella infection [70][71][72] . The median duration of varicella vesicles before developing symptoms of NF is 3 -4 days [52,67] .…”