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Mariani F, Gentili C, Pulcinelli V, Martino L, Valentini P, Buonsenso D. State of the Art of Invasive Group A Streptococcus Infection in Children: A Scoping Review of the Literature with a Focus on Predictors of Invasive Infection. Children (Basel) 2023; 10:1472. [PMID: 37761433 PMCID: PMC10528266 DOI: 10.3390/children10091472] [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] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/21/2023] [Accepted: 08/27/2023] [Indexed: 09/29/2023]
Abstract
Currently, it remains unclear why some children develop invasive group A Streptococcus (iGAS) and how to manage this condition. Therefore, to explore available works in the literature, we performed a scoping review aiming to analyze the current literature on clinical presentation of different illnesses outcomes of iGAS, with a specific focus on predictors of invasive infection, including an assessment of the prodromal stages of the disease and the possible presence of previous non-invasive GAS infections in children that later developed iGAS. METHODS We conducted a systematic search on PubMed and SCOPUS of all pediatric studies reporting iGAS cases, following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. For those studies in which multivariable analysis investigating iGAS risk factors was performed, a second review was performed and reported in detail. RESULTS A total of 209 studies were included. Five studies investigated risk factors for iGAS, the most relevant being varicella infection, chronic underlying illness, presence of the speC gene in GAS strains, acetaminophen and ibuprofen use, children nonwhite, living in low-income households, exposure to varicella at home, persistent high fever, having more than one other child in the home, and new use of NSAIDs. Although we observed a progressive increase in the number of papers published on this topic, no trials investigating the benefits of clindamycin or intravenous immunoglobulins were found and low-to-middle-income countries were found to be poorly represented in the current literature. CONCLUSIONS Our scoping review highlights important gaps regarding several aspects of iGAS in children, including prodromic presentation and optimal treatment strategies. There is also little representation of low-middle-income countries. The current literature does not allow the performance of systematic reviews or meta-analyses, but this work should inform healthcare professionals, policy makers, and funding agencies on which studies to prioritize on this topic.
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Affiliation(s)
- Francesco Mariani
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.M.); (C.G.); (V.P.); (L.M.); (P.V.)
| | - Carolina Gentili
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.M.); (C.G.); (V.P.); (L.M.); (P.V.)
| | - Valentina Pulcinelli
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.M.); (C.G.); (V.P.); (L.M.); (P.V.)
| | - Laura Martino
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.M.); (C.G.); (V.P.); (L.M.); (P.V.)
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.M.); (C.G.); (V.P.); (L.M.); (P.V.)
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.M.); (C.G.); (V.P.); (L.M.); (P.V.)
- Centro di Salute Globale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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van Kempen EB, Bruijning-Verhagen PCJ, Borensztajn D, Vermont CL, Quaak MSW, Janson JA, Maat I, Stol K, Vlaminckx BJM, Wieringa JW, van Sorge NM, Boeddha NP, van Veen M. Increase in Invasive Group a Streptococcal Infections in Children in the Netherlands, A Survey Among 7 Hospitals in 2022. Pediatr Infect Dis J 2023; 42:e122-e124. [PMID: 36728741 DOI: 10.1097/inf.0000000000003810] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Following an increase in notifiable invasive group A streptococcal (iGAS) infections in the Netherlands, we conducted a survey among 7 hospitals. Pediatric iGAS case numbers were 2-fold higher between July 2021 and June 2022 versus pre-COVID-19. A sharp increase occurred early 2022, most pronounced in <5 years old and for diagnoses empyema and necrotizing fasciitis. This recent pediatric iGAS surge warrants investigation and vigilance.
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Affiliation(s)
- Evelien B van Kempen
- From the Department of Paediatrics, Juliana Children's Hospital, Haga Hospital, The Hague
| | | | - Dorine Borensztajn
- Department of Paediatrics, Maasstad Ziekenhuis, Rotterdam
- Department of Paediatrics, Noordwest Ziekenhuisgroep, Alkmaar & Den Helder
| | - Clementien L Vermont
- Department of Paediatrics, Division of Paediatric Infectious Diseases & Immunology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam
| | - Marjolijn S W Quaak
- Department of Paediatrics, Division of Paediatric Infectious Diseases & Immunology, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam
| | - Jo-Anne Janson
- Department of Paediatrics, Maastricht University Medical Center+, Maastricht
| | - Ianthe Maat
- Department of Microbiology, Radboud University Medical Center, Nijmegen
| | - Kim Stol
- Department of Paediatrics, Division of Paediatric Infectious Diseases & Immunology, Amalia Children's Hospital, Radboud University Medical Center, Nijmegen
| | | | | | - Nina M van Sorge
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC location University of Amsterdam, Amsterdam
- Netherlands Reference Center for Bacterial Meningitis, Amsterdam UMC location AMC, Amsterdam, The Netherlands
| | | | - Mirjam van Veen
- From the Department of Paediatrics, Juliana Children's Hospital, Haga Hospital, The Hague
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Nagy A, Reyes JA, Chiasson DA. Fatal Pediatric Streptococcal Infection: A Clinico-Pathological Study. Pediatr Dev Pathol 2022; 25:409-418. [PMID: 35227107 PMCID: PMC9277330 DOI: 10.1177/10935266211064696] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE AND CONTEXT Streptococcal Infection (SI) is an important cause of pediatric death in children, yet limited reports exist on autopsy findings in fatal SI cases. METHOD Case records (1997-2019) of SI with no pre-existing risk factors were reviewed and selected. Their clinical and pathological findings in the autopsy reports were analyzed. RESULTS In our cohort of 38 cases based on bacterial culture results, SI was most commonly caused by Streptococcus pneumoniae (SPn; 45%) and Streptococcus pyogenes (SPy; 37%). 92% of decedents had some prodromal symptoms prior to terminal presentation. The clinical course was often rapid, with 89% found unresponsive, suddenly collapsing, or dying within 24 hours of hospital admission. 64% of deaths were attributed to sepsis, more frequently diagnosed in the SPy group than in the SPn group (71% vs 48%). Pneumonia was found in both SPn and SPy groups, whereas meningitis was exclusively associated with SPn. CONCLUSION Our study shows fatal SI is most commonly caused by either SPn or SPy, both of which are frequently associated with prodromal symptoms, rapid terminal clinical course, and evidence of sepsis. Postmortem diagnosis of sepsis is challenging and should be correlated with clinical features, bacterial culture results, and autopsy findings.
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Affiliation(s)
- Anita Nagy
- Division of Pathology, Department
of Paediatric Laboratory Medicine, The Hospital for Sick
Children, Toronto, ON, Canada,Anita Nagy, Division of Pathology,
Department of Paediatric Laboratory Medicine, The Hospital for Sick Children,
555 Universit venue, Toronto, ON M5G 1X8, Canada.
| | - Jeanette A. Reyes
- Division of Pathology, Department
of Paediatric Laboratory Medicine, The Hospital for Sick
Children, Toronto, ON, Canada
| | - David. A. Chiasson
- Division of Pathology, Department
of Paediatric Laboratory Medicine, The Hospital for Sick
Children, Toronto, ON, Canada,Department of Pathobiology and
Laboratory Medicine, University of Toronto, Toronto, ON, Canada
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Abstract
BACKGROUND Shigella remains the primary cause of diarrhoea in paediatric patients worldwide and accounts for up to 40,000 deaths per year. Current guidelines for the treatment of shigellosis are based on data which are over a decade old. In an era of increasing antimicrobial resistance, an updated review of the appropriate empirical therapy for shigellosis in children is necessary, taking into account susceptibility patterns, cost and the risk of adverse events. METHODS A systematic review of the current published literature on the treatment of shigella dysentery was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). RESULTS The initial search produced 131 results, of which nine studies met the inclusion criteria. The quality of the studies was assessed as per the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. International guidelines were also reviewed. There is a lack of current research regarding the clinical treatment of shigellosis in paediatric and adult patients, despite rising antimicrobial resistance worldwide. In particular, there is a lack of studies assessing the non-susceptibility of community-acquired strains, with almost all published research pertaining to microbiological data from hospital-based settings. DISCUSSION Current WHO guidelines support the use of fluoroquinolones (first-line), β-lactams (second-line) and cephalosporins (second-line) which accords with currently available evidence and other international guidelines, and there is no strong evidence for changing this guidance. Azithromycin is appropriate as a second-line therapy in regions where the rate of non-susceptibility of ciprofloxacin is known to be high, and research suggests that, from a cardiac point of view, azithromycin is safer than other macrolide antibiotics. Cefixime is also a reasonable alternative, although its use must be weighed against the risk of dissemination of extended-spectrum β-lactamase-producing organisms.
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Affiliation(s)
| | - James A. Berkley
- Kenya Medical Research Institute (KEMRI)/Wellcome Trust Research Programme, Kilifi, Kenya
- The Childhood Acute Illness and Nutrition Network (CHAIN), Kilifi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, The University of Oxford, Oxford, UK
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Alexandre M, Wang’ondu R, Cooney, Jr. LM. Group A Streptococcal Bacteremia following Streptococcal Pharyngitis in an Older Patient with Diabetes: A Case Report
. Yale J Biol Med 2017; 90:337-340. [PMID: 28656020 PMCID: PMC5482310] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Group A streptococcus (GAS) is responsible for a wide range of both invasive and noninvasive infections. Severe invasive group A streptococcal infection is associated with morbidity and mortality and has been linked to chronic medical conditions with skin and soft tissues involvement, and intravenous drug use (IVDU). Invasive diseases are, however, rare and have been recognized to affect the extremes of age (younger than 10 years of age and older than 74). We report a case of Group A streptococcus bacteremia following pharyngitis in a 76-year-old diabetic male with no history of IVDU. This report's main goal is to illustrate that chronic illnesses such as diabetes and congestive heart failure might predispose elderly patients to invasive diseases such as Group A streptococcus bacteremia.
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Affiliation(s)
- Mehida Alexandre
- Yale University School of Medicine, New Haven, CT,To whom all correspondence should be addressed: Mehida Alexandre, 367 Cedar Street, Box #410, New Haven, CT 06510, Tel: (631) 452-3402, .
| | - Ruth Wang’ondu
- Department of Internal Medicine-Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Leo M. Cooney, Jr.
- Department Geriatric Medicine, Yale University School of Medicine, New Haven, CT
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Abstract
There is concern of global resurgence of invasive group A Streptococcus (iGAS) infections. We compared the clinical and molecular epidemiology of patients admitted with iGAS over two time periods, 2008 and 2010, in Western Sydney, Australia. The annual incidence was 19 cases per 100,000 admissions in 2008, compared to 33 per 100,000 in 2010. An increasing proportion of patients died (0% versus 13%), had an APACHE II score ≥30 (0% versus 19%), and had no known risk-factors (12% versus 25%). A potential skin source was identified as a trigger in fewer cases in 2010 (36% versus 11%). In total, there were 27 different emm types and 11 different emm clusters. There were some new emm types/clusters in 2010 that were not present in 2008. However, the study was not adequately powered to detect statistically significant differences in the distribution of emm types (p = 0.06) and emm clusters (p = 0.16) between the two years. There were also no clear associations between emm types/clusters and severity and clinical manifestations of iGAS infections. Although the proposed 30-valent M protein vaccine encompasses only 47% of our isolates, it will likely provide coverage for at least 71% of iGAS infections due to cross-opsonisation.
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