Group A streptococcal (GAS) infections amongst children in Europe: Taming the rising tide (original) (raw)
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.
Serious Group A streptococcal diseases in children
The Journal of Pediatrics, 1976
The illnesses of 4O patients with diagnoses of septicemia, cellulitis with bacteremia, pneumonia empyema, and meningitis caused by Streptococcus pyogenes, Group A, are described. Twenty-five of 27 patients (93%) without underlying disease survived, whereas only seven of 13 children (54%) with underlying disease survived. Nine of the 25 patients who were otherwise normal and who survived these infections had prolonged, complicated illnesses. Four of these patients, and one who died, had septicemia without a focus of infection at the time of admission. Streptococcus pyogenes, Group A, although very sensitive to penicillin G and other antibiotics, can cause both severe and rapidly progressive disease in children.
Differences between Belgian and Brazilian Group A Streptococcus Epidemiologic Landscape
PLoS ONE, 2006
Background. Group A Streptococcus (GAS) clinical and molecular epidemiology varies with location and time. These differences are not or are poorly understood. Methods and Findings. We prospectively studied the epidemiology of GAS infections among children in outpatient hospital clinics in Brussels (Belgium) and Brasília (Brazil). Clinical questionnaires were filled out and microbiological sampling was performed. GAS isolates were emm-typed according to the Center for Disease Control protocol. emm pattern was predicted for each isolate. 334 GAS isolates were recovered from 706 children. Skin infections were frequent in Brasília (48% of the GAS infections), whereas pharyngitis were predominant (88%) in Brussels. The mean age of children with GAS pharyngitis in Brussels was lower than in Brasília (65/92 months, p,0.001). emm-typing revealed striking differences between Brazilian and Belgian GAS isolates. While 20 distinct emm-types were identified among 200 Belgian isolates, 48 were found among 128 Brazilian isolates. Belgian isolates belong mainly to emm pattern A-C (55%) and E (42.5%) while emm pattern E (51.5%) and D (36%) were predominant in Brasília. In Brasília, emm pattern D isolates were recovered from 18.5% of the pharyngitis, although this emm pattern is supposed to have a skin tropism. By contrast, A-C pattern isolates were unfrequently recovered in a region where rheumatic fever is still highly prevalent. Conclusions. Epidemiologic features of GAS from a pediatric population were very different in an industrialised country and a low incomes region, not only in term of clinical presentation, but also in terms of genetic diversity and distribution of emm patterns. These differences should be taken into account for designing treatment guidelines and vaccine strategies.
Invasive group B streptococcal infections in Sweden: incidence, predisposing factors and prognosis
International Journal of Infectious Diseases, 2003
Objectives: To study the incidence, clinical manifestations, concomitant conditions and case-fatality rate in patients with invasive group B Streptococcus (GBS) infections in the Goteborg area (mean population 582 666) of Sweden during 1981-95. Design: Patients were identified from the records of the Department of Clinical Bacteriology. Clinical data were obtained from hospital records. Results: GBS was isolated from blood, cerebrospinal fluid or other sterile body fluids from 211 patients with 215 infectious episodes; 108 in neonates, and 107 in non-neonates. The incidence was 2.4/100 000 per year, with the highest rates in neonates and in persons 265 years. The incidence in neonates was 0.92/1000 live births. The most common manifestation was septicemia with unknown focus. Of the neonates, 54% were full term and had no underlying conditions. Of the non-neonates, 15% had no underlying conditions. The most common underlying conditions were preterm delivery in neonates, and arteriosclerotic disease and diabetes mellitus in non-neonates. The case-fatality rates were 13% in neonates and 16% in non-neonates. Conclusions: GBS is an important pathogen in neonates and in adults with concomitant conditions. The morbidity and mortality rates necessitate research to develop GBS vaccines both for women of fertile age and for patients with a wide variety of underlying diseases.
Increasing Incidence of Late-onset Neonatal Invasive Group B Streptococcal Infections in Iceland
Pediatric Infectious Disease Journal, 2011
Background: Group B streptococci (GBS) may cause life-threatening invasive infections in infants. The incidence of these infections has been increasing during the last decades. The aim of the study was to determine the epidemiology of neonatal GBS infections to be able to implement therapeutic and preventive measures more effectively. Methods: A retrospective case study was conducted in Iceland that included all neonates with positive GBS cultures from blood or cerebrospinal fluid during the period 1975 to 2006. Serotyping of all available GBS isolates was performed. Results: A total of 87 children with 89 infections were included in the study. In all, 53 infants had early-onset (EO) GBS infections (occurring Ͻ7 days after birth) and 34 had late-onset (LO) infections (occurring on days 7-90). EO infections increased during the first 3 quartiles of the study period but decreased during the last quartile. LO infections increased throughout the entire study period. GBS was cultured from cerebrospinal fluid in 21 patients; 9 with EO and 12 with LO infections. Premature infants comprised 15 with EO and 14 with LO infections. Eight children died of GBS infection, 7 with EO and 1 with LO infections; no correlation with serotypes was found. Serotype III was most common for both EO (34%) and LO infections (62%). The number of GBS infections increased during the study period. The decrease in EO infections in recent years could be attributed to intrapartum antibiotic treatment. The increasing number of LO infections is a concern.