Group A streptococcal (GAS) infections amongst children in Europe: Taming the rising tide (original) (raw)
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Group A streptococcal disease in paediatric inpatients: a European perspective
European Journal of Pediatrics
Group A streptococcal (GAS) disease shows increasing incidence worldwide. We characterised children admitted with GAS infection to European hospitals and studied risk factors for severity and disability. This is a prospective, multicentre, cohort study (embedded in EUCLIDS and the Swiss Pediatric Sepsis Study) including 320 children, aged 1 month to 18 years, admitted with GAS infection to 41 hospitals in 6 European countries from 2012 to 2016. Demographic, clinical, microbiological and outcome data were collected. A total of 195 (61%) patients had sepsis. Two hundred thirty-six (74%) patients had GAS detected from a normally sterile site. The most common infection sites were the lower respiratory tract (LRTI) (22%), skin and soft tissue (SSTI) (23%) and bone and joint (19%). Compared to patients not admitted to PICU, patients admitted to PICU more commonly had LRTI (39 vs 8%), infection without a focus (22 vs 8%) and intracranial infection (9 vs 3%); less commonly had SSTI and bone and joint infections (p < 0.001); and were younger (median 40 (IQR 21-83) vs 56 (IQR 36-85) months, p = 0.01). Six PICU patients (2%) died. Sequelae at discharge from hospital were largely limited to patients admitted to PICU (29 vs 3%, p < 0.001; 12% overall) and included neurodisability, amputation, skin grafts, hearing loss and need for surgery. More patients were recruited in winter and spring (p < 0.001). Conclusion: In an era of observed marked reduction in vaccine-preventable infections, GAS infection requiring hospital admission is still associated with significant severe disease in younger children, and short-and long-term morbidity. Further advances are required in the prevention and early recognition of GAS disease. What is Known: • Despite temporal and geographical variability, there is an increase of incidence of infection with group A streptococci. However, data on the epidemiology of group A streptococcal infections in European children is limited. What is New: • In a large, prospective cohort of children with community-acquired bacterial infection requiring hospitalisation in Europe, GAS was the most frequent pathogen, with 12% disability at discharge, and 2% mortality in patients with GAS infection. • In children with GAS sepsis, IVIG was used in only 4.6% of patients and clindamycin in 29% of patients.
medRxiv (Cold Spring Harbor Laboratory), 2022
Based on a survey sent to seven Dutch hospitals, we observed an substantial increase in invasive group A streptococcal infections in children in the Netherlands, comparing the pre-COVID-19 pandemic cohort of 2018-2019 to 2021-2022. The most affected age group were children between 0-5 years. Main diagnosis was pneumonia with empyema. Necrotizing fasciitis and streptococcal toxic shock syndrome were also reported in 11% and 7% respectively. A significant number was admitted to the Paediatric Intensive Care Unit. Vigilance is needed. Statements Ethical statement: This study was conducted in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines. This study was conducted in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines. The ethical review board (MEC-U, reference number W18.201) deemed that the Medical Research Involving Human Subjects Act (WMO) does not apply to our study.
Invasive group A streptococcal infections in children: an emerging infectious disease in Turkey
Annals of Tropical Paediatrics, 2004
Background: The incidence of invasive group A streptococcus (iGAS) infections varies in time and geographically for unknown reasons. We performed a nationwide survey to assess the population-based incidence rates and outcomes of children with iGAS infections. Methods: We collected data on patients from hospital discharge registries and the electronic databases of microbiological laboratories in Finland for the period 1996-2010. We then recorded the emm types or serotypes of the strains. The study physician visited all university clinics and collected the clinical data using the same data entry sheet. Results: We identified 151 children with iGAS infection. Varicella preceded iGAS infection in 20% of cases and fasciitis infection in 83% of cases. The annual incidence rate of iGAS infection was 0.93 per 100,000
Streptococcal Infections in Children: An Update
Pediatric Infectious Disease, 2019
Streptococcus is the general term for a diverse group of gram-positive cocci that appear in chains or pairs. The most prevalent of the human streptococcal pathogens are the Lancefield group A Streptococcus (GAS). This review article provides an update on group A streptococcal infections with key highlights on classification, presentation, the latest diagnostic criteria, management protocols, and complications. Background: Group A Streptococcus is involved in the pathogenesis of a wide variety of pathologic conditions varying from noninvasive infections such as pharyngitis, erysipelas, scarlet fever, and cellulitis to invasive diseases, such as bacterial sepsis, streptococcal toxic shock syndrome, and necrotizing fasciitis. It is also linked with nonsuppurative and postinfectious immunological sequelaes, such as acute rheumatic fever (ARF), post-streptococcal glomerulonephritis (PSGN) and pediatric autoimmune neuropsychiatric disorder associated with Streptococcus pyogenes (PANDAS). Globally around 18 million people suffer from GAS-related illnesses. Conclusion: Group A streptococcal infections have a high prevalence and morbidity across the globe, especially in developing countries. Children older than 3 years have a higher risk of such complications necessitating need for proper diagnosis and treatment.
Long-term surveillance of invasive group A streptococcal disease in The Netherlands, 1994-2003
Clinical Microbiology and Infection, 2005
An active, nationwide laboratory-based surveillance study of invasive group A streptococcal (GAS) infections was conducted in The Netherlands from May 1994 until December 2003 (average population during this period was 15 729 704). Microbiologically invasive isolates were obtained from 1504 patients, with most (70%) isolates cultured from blood. There was a clear seasonal pattern in invasive streptococcal infections, with an estimated annual incidence that peaked in 1996 (4.0 cases ⁄ 100 000 individuals ⁄ year) and was at its lowest in 1999 (2.0 cases ⁄ 100 000 individuals ⁄ year). Twenty-eight different M-types were identified, of which the most frequent were M1 (339 ⁄ 1504, 23%), M3 (187 ⁄ 1504, 12%), M89 (174 ⁄ 1504, 12%), M28 (164 ⁄ 1504, 11%), M12 (109 ⁄ 1504, 7%) and M6 (55 ⁄ 1504, 4%). There was a high degree of variation in the relative annual contributions of the predominant M-types, but variations in M1 and M3 combined correlated with overall changes in the annual incidence. The contribution of the patient group aged ≥ 56 years to all cases of invasive GAS disease increased during the study period, whereas that of the group aged 0-20 years decreased. A peak in the incidence of invasive GAS disease among the patient group aged 30-34 years did not vary during the study period, indicating that the high incidence of invasive GAS disease in this age group was age-specific rather than cohort-related.
European Journal of Clinical Microbiology & Infectious Diseases
Assess the incidence, risk factors, clinical and microbiological features, and outcome of both probable invasive and invasive group A Streptococcus (GAS) infections in children and adults in the BrusselsCapital Region between 2005 and 2020. A retrospective, multicentric study was performed in three university hospitals in Brussels. Patients were identified through the centralized laboratory information system. Epidemiological and clinical data were collected from patients' hospital records. A total of 467 cases were identified. Incidence has increased from 2.1 to 10.9/100,000 inhabitants between 2009 and 2019 in non-homeless adults while it was above 100/100,000 on homeless in years with available denominators. Most of GAS were isolated from blood (43.6%), and the most common clinical presentation was skin and soft tissue infections (42.8%). A third of all the patients needed surgery, a quarter was admitted to the intensive care unit, and 10% of the adult patients died. Wounds and chickenpox disease were the main risk factors for children. Tobacco, alcohol abuse, wounds or chronic skin lesion, being homeless, and diabetes were identified as major predisposing factors for adults. The most common emm clusters were D4, E4, and AC3; 64% of the isolates were theoretically covered by the 30-valent M-protein vaccine. The burden of invasive and probable invasive GAS infections is on the rise in the studied adult population. We identified potential interventions that could contribute to decrease this burden: appropriate care of wounds, specifically among homeless and patients with risk factors such as diabetes and systematic chickenpox vaccination for children.
Comparison of Clinical Characteristics of Group A Streptococcal Bacteremia in Children and Adults
Clinical Infectious Diseases, 1996
This report reviews 55 cases of bacteremia due to group A streptococci (GAS) in patients treated at the University Hospital of Infectious Diseases, in Zagreb, Croatia, during the period 1974-1994. Clinical findings for 27 children (age, <18 years) were compared with those for 28 adults. A clear predominance of the respiratory tract as a primary focus of infection in younger patients was observed (P = .00006). Children were more frequently colonized by GAS in their throats than were adults (P = .04). Suppurative osteoarticular metastatic foci were more often found in children (P = .02). Acute underlying conditions were more common in children (P = .04), whereas chronic underlying conditions were more common in adults (P = .00005). The case fatality rate was 23% among children (6 of 27) and 50% among patients aged > 60 years (5 of 10).The course of bacteremia due to GAS was benign in eight children (29.6%) and 12 adults (42.8%). Our experience suggests that there are significant differences in the presentation of bacteremia due to GAS in children and adults.
Group A streptococcus bacteraemia: comparison of adults and children in a single medical centre
Clinical Microbiology and Infection, 2006
Group A streptococcus (GAS) bacteraemia is often associated with soft-tissue infection, with significant morbidity and mortality. Little is known concerning the differences between adults and children with GAS bacteraemia. Records for 98 of 116 cases of GAS bacteraemia (60 adults and 38 children, aged 7 days to 96 years) occurring during a 10-year period (1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002) were located and reviewed. GAS bacteraemia comprised 0.6% of all bacteraemias in adults, compared to 3.3% in children (p < 0.001). The rate of adult GAS bacteraemia was two cases ⁄ 1000 hospitalisations, compared to 13/1000 in children (p < 0.001). Seventy-six (78%) patients had concomitant tissue involvement, with skin or soft-tissue infection being the most common (62%). Fifty-three (88%) of 60 adults and five (13%) of 38 children had underlying conditions (p < 0.001). Twelve patients died, only one of whom was a child. Parameters associated with mortality were older age, lower temperature, hypotension, a need for surgical intervention, toxic shock syndrome, disseminated intravascular coagulation, thrombocytopenia, lymphopenia, hypocalcaemia, renal failure and acidosis (p < 0.05).
Infektološki glasnik
Aim: Beta-haemolytic streptococci (BHS) rarely cause invasive disease (ID). Usually the most common cause of ID is group B BHS (BHS-B). However, in our recent routine work higher number of group A BHS (BHS-A) isolates from blood was noted. The aim of this study was to report trends and findings by group BHS-A and BHS-B causing laboratory confirmed disease from 2011 to 2018 at the University Hospital for Infectious Diseases „Dr. Fran Mihaljević”. Methods: Data on patients from the electronic database of microbiological laboratory at UHID for the period 2011-2018 was collected and analysed. Results: During the period 2011-2018, 151 BHS A and B were identified from normally sterile body sites. Most isolates were from blood cultures (96.7%). BHS-A and BHS-B were isolated almost equally. The highest number of isolates was recorded in 2012 and 2017. The number of BHS A isolates peaked in 2012, 54% more than BHS-B, and 50% more in 2016. Children presented 19.9% of patients, and were mostly...