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Taylor A, Webb R. Fifteen-minute consultation: Group A streptococcal pharyngitis, diagnosis and treatment in children. Arch Dis Child Educ Pract Ed 2024:edpract-2023-325755. [PMID: 38514137 DOI: 10.1136/archdischild-2023-325755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 01/10/2024] [Indexed: 03/23/2024]
Abstract
Group A streptococcus (GAS) is the most common bacterial cause of pharyngitis in children. GAS causes significant suppurative and non-suppurative complications including invasive GAS disease and acute rheumatic fever. This article describes the current epidemiology and clinical presentation of GAS pharyngitis and explores how diagnostic and treatment decisions differ globally. Several key decision support tools are discussed including international guidelines, clinical decision scores and laboratory tests along with the evidence for treatment choice and duration. With recent international reports describing an increase in GAS infections, clinicians should be familiar with their local GAS pharyngitis guidelines and the rationale for diagnosis and treatment of this common childhood illness.
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Affiliation(s)
- Amanda Taylor
- Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Rachel Webb
- Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
- Paediatric Infectious Diseases, Starship Children's Health, Auckland, New Zealand
- Paediatrics, Kidz First Hospital, Counties Manukau, Auckland, New Zealand
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Abo YN, Oliver J, McMinn A, Osowicki J, Baker C, Clark JE, Blyth CC, Francis JR, Carr J, Smeesters PR, Crawford NW, Steer AC. Increase in invasive group A streptococcal disease among Australian children coinciding with northern hemisphere surges. Lancet Reg Health West Pac 2023; 41:100873. [PMID: 38223399 PMCID: PMC10786649 DOI: 10.1016/j.lanwpc.2023.100873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/23/2023] [Indexed: 01/16/2024]
Abstract
Background Increases in invasive group A streptococcal disease (iGAS) have recently been reported in multiple countries in the northern hemisphere, occurring during, and outside of, typical spring peaks. We report the epidemiology of iGAS among children in Australia from 1 July 2018 to 31 December 2022. Methods The Paediatric Active Enhanced Disease Surveillance (PAEDS) Network prospectively collected iGAS patient notifications for children and young people aged less than 18 years admitted to five major Australian paediatric hospitals in Victoria, Queensland, Western Australia and the Northern Territory. Patients were eligible for inclusion if they had GAS isolated from a normally sterile body site, or met clinical criteria for streptococcal toxic shock syndrome or necrotising fasciitis with GAS isolated from a non-sterile site. We report patients' clinical and demographic characteristics, and estimate minimum incidence rates. Findings We identified 280 paediatric iGAS patients, median age 4.5 years (interquartile range 1.4-6.4). We observed a pre-pandemic peak annualised incidence of 3.7 per 100,000 (95% CI 3.1-4.4) in the 3rd quarter of 2018, followed by a decline to less than 1.0 per 100,000 per quarter from 2020 to mid-2021. The annualised incidence increased sharply from mid-2022, peaking at 5.2 per 100,000 (95% CI 4.4-6.0) in the 3rd quarter and persisting into the 4th quarter (4.9 per 100,000, 95% CI 4.2-5.7). There were 3 attributable deaths and 84 (32%) patients had severe disease (overall case fatality rate 1%, 95% CI 0.2-3.3). Respiratory virus co-infection, positive in 57 of 119 patients tested, was associated with severe disease (RR 1.9, 95% CI 1.2-3.0). The most common emm-type was emm-1 (60 of 163 isolates that underwent emm-typing, 37%), followed by emm-12 (18%). Interpretation Australia experienced an increase in the incidence of iGAS among children and young people in 2022 compared to pandemic years 2020-2021. This is similar to northern hemisphere observations, despite differences in seasons and circulating respiratory viruses. Outbreaks of iGAS continue to occur widely. This emphasises the unmet need for a vaccine to prevent significant morbidity associated with iGAS disease. Funding Murdoch Children's Research Institute funded open access publishing of this manuscript.
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Affiliation(s)
- Yara-Natalie Abo
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Infectious Diseases Unit, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Microbiology, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Oliver
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Victoria, Australia
| | - Alissa McMinn
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Joshua Osowicki
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Infectious Diseases Unit, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Ciara Baker
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Julia E. Clark
- Queensland Children's Hospital, Queensland and School of Clinical Medicine, University of Queensland, Australia
| | - Christopher C. Blyth
- Telethon Kids Institute, University of Western Australia and Perth Children's Hospital, Western Australia, Australia
| | - Joshua R. Francis
- Royal Darwin Hospital, Northern Territory, Australia
- Menzies School of Health Research, Charles Darwin University, Northern Territory, Australia
| | - Jeremy Carr
- Infection & Immunity, Monash Children's Hospital, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Pierre R. Smeesters
- Department of Paediatrics, Brussels University Hospital, Academic Children Hospital Queen Fabiola, Université libre de Bruxelles, 1020 Brussels, Belgium
- Molecular Bacteriology Laboratory, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Nigel W. Crawford
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Andrew C. Steer
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Infectious Diseases Unit, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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Taylor A, Elliott BM, Atkinson J, Roberts S, Voss L, Best EJ, Webb R. Group A Streptococcus Primary Peritonitis in Children, New Zealand. Emerg Infect Dis 2023; 29. [PMID: 37878292 PMCID: PMC10617357 DOI: 10.3201/eid2911.230211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
Group A Streptococcus (GAS) primary peritonitis is a rare cause of pediatric acute abdomen (sudden onset of severe abdominal pain); only 26 pediatric cases have been reported in the English language literature since 1980. We discuss 20 additional cases of pediatric primary peritonitis caused by GAS among patients at Starship Children's Hospital, Auckland, New Zealand, during 2010-2022. We compare identified cases of GAS primary peritonitis to cases described in the existing pediatric literature. As rates of rates of invasive GAS increase globally, clinicians should be aware of this cause of unexplained pediatric acute abdomen.
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Engstrom EE, Plattner AS, McNeil JC, Hulten KG, Reich PJ, Boyle MG, Dunn JJ, Fritz SA, Kaplan SL. Invasive Community-Onset Gram-Positive Infections From July 2018 Through December 2022 at 2 Children's Hospitals. Open Forum Infect Dis 2023; 10:ofad563. [PMID: 38023538 PMCID: PMC10681712 DOI: 10.1093/ofid/ofad563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/08/2023] [Indexed: 12/01/2023] Open
Abstract
Background Invasive infections caused by Streptococcus pyogenes (invasive group A streptococcus [iGAS]) and Streptococcus pneumoniae (invasive pneumococcal disease [IPD]) decreased substantially at the beginning of the COVID-19 pandemic. Our study sought to evaluate the extent of this decrease and the trends of these infections since reversion of societal adjustments incident to the pandemic. We also wanted to compare the frequency of these infections with invasive community-onset Staphylococcus aureus (I-CO-SA) infections and common respiratory viral infections in this period. Methods Cases of iGAS, IPD, and I-CO-SA infections were identified prospectively and retrospectively at 2 large US children's hospitals by positive cultures from July 2018 through December 2022. Admission data were used to estimate frequency. For comparison, rates of respiratory syncytial virus (RSV), influenza, and SARS-CoV-2 were estimated by the number of positive viral test results at each institution. Results I-CO-SA infections showed little variation in the study period. Rates of iGAS infection and IPD decreased by 46% and 44%, respectively, from 2019 to 2020, coinciding with a substantial decrease in RSV and influenza. In 2022, RSV and influenza infection rates increased to prepandemic winter season rates, coinciding with a return to prepandemic rates of IPD (225% increase from 2021 to 2022) and a surge above prepandemic rates of iGAS infections (543% increase from 2021 to 2022). Conclusions The COVID-19 pandemic had an unexpected influence on IPD and iGAS infections that was temporally related to changes in rates of viral infections.
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Affiliation(s)
- Eric E Engstrom
- Department of Pediatrics, Division of Infectious Diseases, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Alexander S Plattner
- Department of Pediatrics, Division of Infectious Diseases, Washington University in St Louis and St Louis Children's Hospital, St Louis, Missouri, USA
| | - J Chase McNeil
- Department of Pediatrics, Division of Infectious Diseases, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Kristina G Hulten
- Department of Pediatrics, Division of Infectious Diseases, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Patrick J Reich
- Department of Pediatrics, Division of Infectious Diseases, Washington University in St Louis and St Louis Children's Hospital, St Louis, Missouri, USA
| | - Mary G Boyle
- Department of Pediatrics, Division of Infectious Diseases, Washington University in St Louis and St Louis Children's Hospital, St Louis, Missouri, USA
| | - James J Dunn
- Department of Pediatrics, Division of Infectious Diseases, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Stephanie A Fritz
- Department of Pediatrics, Division of Infectious Diseases, Washington University in St Louis and St Louis Children's Hospital, St Louis, Missouri, USA
| | - Sheldon L Kaplan
- Department of Pediatrics, Division of Infectious Diseases, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
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Hla TK, Cannon JW, Bowen AC, Wyber R. Getting to grips with invasive group A streptococcal infection surveillance in Australia: are we experiencing an epidemic? Med J Aust 2023; 219:242-245. [PMID: 37598382 DOI: 10.5694/mja2.52056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/27/2023] [Accepted: 06/28/2023] [Indexed: 08/22/2023]
Affiliation(s)
- Thel K Hla
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA
- University of Western Australia, Perth, WA
| | - Jeffrey W Cannon
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA
| | - Asha C Bowen
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA
- Perth Children's Hospital, Perth, WA
| | - Rosemary Wyber
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA
- National Centre for Aboriginal and Torres Strait Islander Wellbeing Research, Australian National University, Canberra, ACT
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Gouveia C, Bajanca-Lavado MP, Mamede R, Araújo Carvalho A, Rodrigues F, Melo-Cristino J, Ramirez M, Friães A. Sustained increase of paediatric invasive Streptococcus pyogenes infections dominated by M1 UK and diverse emm12 isolates, Portugal, September 2022 to May 2023. Euro Surveill 2023; 28:2300427. [PMID: 37676143 PMCID: PMC10486195 DOI: 10.2807/1560-7917.es.2023.28.36.2300427] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 09/07/2023] [Indexed: 09/08/2023] Open
Abstract
Since autumn 2022, observed numbers of paediatric invasive group A Streptococcus infections in Portugal (n = 89) were higher than in pre-COVID-19 seasons. Between September 2022 and May 2023, the dominant diagnoses were pneumonia (25/79), mostly with empyema (20/25), and sepsis (22/79). A number of cases required admission to intensive care (27/79) and surgery (35/79), and the case fatality rate was 5.1% (4/79). Genomic sequencing (n = 55) revealed multiple genetic lineages, dominated by the M1UK sublineage (26/55) and more diverse emm12 isolates (12/55).
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Affiliation(s)
- Catarina Gouveia
- Infectious Diseases Unit, Pediatric Department, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Maria Paula Bajanca-Lavado
- Laboratório Nacional de Referência a Infeções Respiratórias a Agentes Bacterianos, Departamento de Doenças Infeciosas, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisbon, Portugal
| | - Rafael Mamede
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Ana Araújo Carvalho
- Infectious Diseases Unit, Pediatric Department, Hospital de Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Fernanda Rodrigues
- Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - José Melo-Cristino
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Mario Ramirez
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Ana Friães
- Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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