Unexpected Increase in Invasive Group A Streptococcal Infections in Children After Respiratory Viruses Outbreak in France: A 15-Year Time-Series Analysis

Lassoued, Yannis; Assad, Zein; Ouldali, Naïm; Caseris, Marion; Mariani, Patricia; Birgy, André; Bonacorsi, Stéphane; Bidet, Ph.; Faye, Albert

doi:10.1093/ofid/ofad188

Cited by 47 publications

(34 citation statements)

References 17 publications

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“…29 The strength of this study is that it enabled us to generate hypotheses about the pathophysiology of PI based on the inflammatory evolutionary profile of the patients. In a context of increasing PI caused by S. pyogenes, [30][31][32][33] with more severe presentations, 34 the identification of an inflammatory rebound on which corticosteroid therapy could act is of particular importance. However, this study also has limitations such as its monocentric nature, which limits the generalizability of our results, as well as its retrospective nature and small sample size, which do not allow to make definitive recommendations.…”

Section: Discussionmentioning

confidence: 99%

Inflammatory rebound and postinfectious inflammatory response in children with pleural infection: A single‐center retrospective study

Poirault,

Hadchouel,

Roy

et al. 2024

Pediatric Pulmonology

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IntroductionAs pleural inflammation plays a central role in pleural infection (PI), corticosteroids are increasingly being considered as a potential therapy. However, the timing of treatment and the identification of patients who might benefit most remain unresolved. The aim of this study was therefore to investigate the inflammatory trajectories of children with PI.MethodsThis retrospective single‐center study included children aged 3 months to 17 years and 11 months hospitalized for PI due to Streptococcus pyogenes, Streptococcus pneumonia, and Staphylococcus aureus over 10 years. An inflammatory rebound was defined biologically as a reincrease in C‐reactive protein (CRP) of at least 50 mg/L after an initial decrease in CRP of at least 50 mg/L.ResultsWe included 53 cases of PI, including 16 due to S. pyogenes, 27 due to S. pneumonia, and 10 due to S. aureus. An inflammatory rebound occurred in 20 patients (38%) after a median of 4.5 (3−6) days. This inflammatory rebound occurred in 9 (56%) children with S. pyogenes, 8 (30%) children with S. pneumonia, and 3 (30%) children with S. aureus. Children with an inflammatory rebound also had a higher rate of persistent fever after Day 7 and a longer length of stay (p = .01 for both).ConclusionWe postulate that the inflammatory rebound identified in nearly 40% of our patients corresponds to an early postinfectious inflammatory response, and thus that corticosteroids may be most beneficial for children with PI if administered early (between Days 2 and 5).

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Section: Discussionmentioning

confidence: 99%

Inflammatory rebound and postinfectious inflammatory response in children with pleural infection: A single‐center retrospective study

Poirault,

Hadchouel,

Roy

et al. 2024

Pediatric Pulmonology

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“…[4][5][6] Subsequently, after these NPIs were relaxed in the spring of 2021, unusual outbreaks of viral and bacterial pathogens were reported in France and other countries. [7][8][9] Given the suspected role of seasonal pathogens in the pathophysiology of HSP, we hypothesized that these unprecedented changes in the circulation of seasonal pathogens after the implementation and then relaxation of NPIs would represent a unique opportunity to better identify the role of individual seasonal pathogens in the epidemiology of HSP.…”

Section: Introductionmentioning

confidence: 99%

“…The SARS-CoV-2 pandemic led to a marked reduction in the circulation of infectious pathogens in the pediatric population as a result of international nonpharmaceutical interventions (NPIs), such as social distancing and mask wearing . Subsequently, after these NPIs were relaxed in the spring of 2021, unusual outbreaks of viral and bacterial pathogens were reported in France and other countries . Given the suspected role of seasonal pathogens in the pathophysiology of HSP, we hypothesized that these unprecedented changes in the circulation of seasonal pathogens after the implementation and then relaxation of NPIs would represent a unique opportunity to better identify the role of individual seasonal pathogens in the epidemiology of HSP.…”

Section: Introductionmentioning

confidence: 99%

Common Seasonal Pathogens and Epidemiology of Henoch-Schönlein Purpura Among Children

Felix,

Assad,

Bidet

et al. 2024

JAMA Netw Open

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ImportanceHenoch-Schönlein purpura (HSP) is the most common type of vasculitis in children. The factors that trigger the disease are poorly understood. Although several viruses and seasonal bacterial infections have been associated with HSP, differentiating the specific associations of these pathogens with the onset of HSP remains a challenge due to their overlapping seasonal patterns.ObjectiveTo analyze the role of seasonal pathogens in the epidemiology of HSP.Design, Setting, and ParticipantsThis cohort study comprised an interrupted time-series analysis of patient records from a comprehensive national hospital-based surveillance system. Children younger than 18 years hospitalized for HSP in France between January 1, 2015, and March 31, 2023, were included.ExposureImplementation and relaxation of nonpharmaceutical interventions (NPIs) for the COVID-19 pandemic, such as social distancing and mask wearing.Main Outcomes and MeasuresThe main outcomes were the monthly incidence of HSP per 100 000 children, analyzed via a quasi-Poisson regression model, and the estimated percentage of HSP incidence potentially associated with 14 selected common seasonal pathogens over the same period.ResultsThe study included 9790 children with HSP (median age, 5 years [IQR, 4-8 years]; 5538 boys [56.4%]) and 757 110 children with the infectious diseases included in the study (median age, 0.7 years [IQR, 0.2-2 years]; 393 697 boys [52.0%]). The incidence of HSP decreased significantly after implementation of NPIs in March 2020 (−53.6%; 95% CI, −66.6% to −40.6%; P &lt; .001) and increased significantly after the relaxation of NPIs in April 2021 (37.2%; 95% CI, 28.0%-46.3%; P &lt; .001). The percentage of HSP incidence potentially associated with Streptococcus pneumoniae was 37.3% (95% CI, 22.3%-52.3%; P &lt; .001), the percentage of cases associated with Streptococcus pyogenes was 25.6% (95% CI, 16.7%-34.4%; P &lt; .001), and the percentage of cases associated with human rhino enterovirus was 17.1% (95% CI, 3.8%-30.4%; P = .01). Three sensitivity analyses found similar results.Conclusions and RelevanceThis study found that significant changes in the incidence of HSP simultaneously with major shifts in circulating pathogens after NPIs for the COVID-19 pandemic indicated that approximately 60% of HSP incidence was potentially associated with pneumococcus and group A streptococcus. This finding suggests that preventive measures against these pathogens could reduce the incidence of pediatric HSP.

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“…An increase in group A Streptococcus (GAS) infections, particularly invasive group A Streptococcus (iGAS) disease and also scarlet fever, was reported in Europe and United States in 2022, above seasonally expected levels, with commensurate increase in number of deaths. 1–9 An analysis of pediatric iGAS in Portugal, from September 2022 to February 2023, has also shown significantly higher number of cases than in the same period of prepandemic years. It was not associated with an emerging new lineage but with multiple lineages previously circulating in Portugal, with a clear dominance of the M1 UK sublineage and emm 12.…”

mentioning

confidence: 99%

“…Decreased exposure to group A Streptococci during the COVID-19 pandemic and intense circulation of resurgent respiratory viruses with frequent viral coinfections in children presenting with iGAS infection, in particular respiratory syncytial virus (RSV), influenza virus and varicella virus, have been proposed as explanations for this observation. 1–4…”

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confidence: 99%

Postpandemic Rebound in Noninvasive Group a Streptococcal Disease is not Synchronous with Winter RSV and Influenza Epidemics

De Beir,

Lucas,

Jesus

et al. 2024

Pediatric Infectious Disease Journal

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An increase in invasive group A Streptococcus infections was reported in 2022, associated with intense respiratory virus circulation. We describe a marked increase of noninvasive group A Streptococcus infections. Although the rise coincided with epidemics of respiratory syncytial virus and influenza, it continued after detection of these viruses fell to low levels, suggesting that other factors have contributed to this epidemiological change.

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Unexpected Increase in Invasive Group A Streptococcal Infections in Children After Respiratory Viruses Outbreak in France: A 15-Year Time-Series Analysis

Cited by 47 publications

References 17 publications

Inflammatory rebound and postinfectious inflammatory response in children with pleural infection: A single‐center retrospective study

Inflammatory rebound and postinfectious inflammatory response in children with pleural infection: A single‐center retrospective study

Common Seasonal Pathogens and Epidemiology of Henoch-Schönlein Purpura Among Children

Postpandemic Rebound in Noninvasive Group a Streptococcal Disease is not Synchronous with Winter RSV and Influenza Epidemics

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