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A strep in the wrong direction – invasive group a streptococcal disease
  1. S Mitchell,
  2. L Jones
  1. General Paediatrics, RHSC, Edinburgh, UK

Abstract

Tonsillitis, impetigo, necrotising fasciitis, toxic shock … Group A Streptococcus or Streptococcus Pyogenes can cause a wide spectrum of disease and often opportunistically follows VZV infection. Invasive Group A Streptococcal disease or iGAS (defined as positive cultures from sterile body sites or non sterile sites where the child had toxic shock syndrome) has a 3–4 times greater mortality than meningococcal disease. Virulent strains of Group A Strep with enhanced pathogenic potential are increasing across the UK.

Aim To determine the incidence of iGAS in our local paediatric population in 2007–2010.

Methods We examined all positive Group A Streptococcal isolates for children seen at our tertiary paediatric centre from 1 May 2007 to 30 September 2010. We reviewed the clinical notes for those children with invasive Group A Streptococcal disease.

Results We found that there has been a substantial increase in the number of invasive Group A Streptococcal infections within our local paediatric population, in particular over the last year. There were 38 cases of iGAS infection over this time period, with 17 cases (45%) seen in the last 12 months of the study. The median age of presentation was 2 years of age (range 1 month to 14 years) with a 47%:53% girl to boy ratio. Seven children had osteomyelitis/septic arthritis, five children had an empyema and three had Streptococcal Toxic Shock Syndrome. There was one death directly attributable to the disease. Eight children required ITU care. The mean length of stay was 9 days (range 1 day to 39 days). Of note, fice children received less than the recommended 10 days of antibiotics for their infections.

Conclusion This study highlights the increased incidence of iGAS infection and the serious sequelae it can confer. It is a formidable bacterial infection, which demands careful management with adequate antimicrobial treatment and medical follow-up.

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