1
|
Lees EA, Williams TC, Marlow R, Fitzgerald F, Jones C, Lyall H, Bamford A, Pollock L, Smith A, Lamagni T, Kent A, Whittaker E. Epidemiology and Management of Pediatric Group A Streptococcal Pneumonia With Parapneumonic Effusion: An Observational Study. Pediatr Infect Dis J 2024; 43:841-850. [PMID: 38900036 PMCID: PMC11319078 DOI: 10.1097/inf.0000000000004418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND During autumn/winter 2022, UK pediatricians reported an unseasonal increase in invasive group A streptococcal infections; a striking proportion presenting with pneumonia with parapneumonic effusion. METHODS Clinicians across the United Kingdom were requested to submit pseudonymized clinical data using a standardized report form for children (<16 years) admitted between September 30, 2022 and February 17, 2023, with microbiologically confirmed group A streptococcal pneumonia with parapneumonic effusion. RESULTS From 185 cases submitted, the median patient age was 4.4 years, and 163 (88.1%) were previously healthy. Respiratory viral coinfection was detected on admission for 101/153 (66.0%) children using extended respiratory pathogen polymerase chain reaction panel. Molecular testing was the primary method of detecting group A streptococcus on pleural fluid (86/171; 50.3% samples). Primary surgical management was undertaken in 171 (92.4%) children; 153/171 (89.4%) had pleural drain inserted (96 with fibrinolytic agent), 14/171 (8.2%) had video-assisted thoracoscopic surgery. Fever duration after admission was prolonged (median, 12 days; interquartile range, 9-16). Intravenous antibiotic courses varied in length (median, 14 days; interquartile range, 12-21), with many children receiving multiple broad-spectrum antibiotics, although evidence for additional bacterial infection was limited. CONCLUSIONS Most cases occurred with viral coinfection, a previously well-recognized risk with influenza and varicella zoster, highlighting the need to ensure routine vaccination coverage and progress on vaccines for other common viruses (eg, respiratory syncytial virus, human metapneumovirus) and for group A streptococcus. Molecular testing is valuable to detect viral coinfection and confirm invasive group A streptococcal diagnosis, expediting the incorporation of cases into national reporting systems. Range and duration of intravenous antibiotics administered demonstrated the need for research on the optimal duration of antimicrobials and improved stewardship.
Collapse
Affiliation(s)
- Emily A. Lees
- From the Department of Paediatrics, University of Oxford, Children’s Hospital Oxford, Oxford, United Kingdom
- Fitzwilliam College, University of Cambridge, Cambridge, United Kingdom
| | - Thomas C. Williams
- Department of Child Life and Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Robin Marlow
- Bristol Royal Hospital for Children, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, United Kingdom
- Bristol Vaccine Centre, Schools of Population Health Sciences and of Cellular and Molecular Medicine, University of Bristol, Bristol, United Kingdom
| | - Felicity Fitzgerald
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK United Kingdom
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, London, United Kingdom
| | - Christine Jones
- Faculty of Medicine and Institute for Life Sciences, University of Southampton, Southampton, United Kingdom
- NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Hermione Lyall
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK United Kingdom
| | - Alasdair Bamford
- Department of Infectious Diseases, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
- Infection, Immunity, and Inflammation Department, UCL Great Ormond Street Institute of Child Health, London
| | - Louisa Pollock
- Department of Paediatric Infectious Diseases and Immunology, Royal Hospital for Children, Glasgow, United Kingdom
| | - Andrew Smith
- College of Medical, Veterinary and Life Sciences, Glasgow Dental School, University of Glasgow, Glasgow, United Kingdom
| | - Theresa Lamagni
- Healthcare-Associated Infection & Antimicrobial Resistance Division, UK Health Security Agency, London, United Kingdom
| | - Alison Kent
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK United Kingdom
| | - Elizabeth Whittaker
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK United Kingdom
- Section of Paediatric Infectious Disease, Department of Infectious Disease, Imperial College London, London, United Kingdom
| |
Collapse
|
2
|
Ahmed MI, Saunders RV, Bandi S. Group A Streptococcal Infections in Children. Curr Pediatr Rev 2021; 17:70-73. [PMID: 32621721 DOI: 10.2174/1573396316666200704152246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 05/25/2020] [Accepted: 05/31/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Invasive group A streptococcal disease (iGAS) can have varied clinical presentations in children, are responsible for prolonged hospital stays and can cause mortality and long-term morbidity in children. Over the last decade, there has been an increase in the incidence of iGAS infections in the UK and worldwide. This has renewed the focus on early diagnosis, management and prevention of this disease. AIMS AND OBJECTIVES The aim of this study was to review the varied clinical presentations and management of children with iGAS infections. METHODS We reviewed the data of children admitted to our tertiary Children's Hospital who had positive isolation of Group A Streptococcus( GAS) from sterile site cultures over the last 8 years. We reviewed their clinical presentations and management including treatment given (antibiotics and duration), outcome and follow up. RESULTS A total of 57 children had iGAS during the study period. The incidence of iGAS was 6-7 cases per year during the study period, except for 2015 when we had 11 cases. The mean length of stay of children admitted with iGAS was 11 days (range 2- 35 days). 21.1% children were admitted to intensive care during their hospital stay. Fever was the most common presenting symptom. Pneumonia with or without empyema was the most common Diagnosis. Initial antibiotic management was varied with ceftriaxone the most commonly used antibiotic in 30% of the cases. 50% of children had their antimicrobial therapy optimised to IV benzylpenicillin after the confirmed isolation of GAS. 7 Children were re-admitted for further treatment and needed a further course of antibiotics. 4 children (7%) died due to iGAS infection. CONCLUSION Our study highlighted the varied symptomatology and management practices in children with iGAS and showed that early diagnosis and prompt initiation of appropriate antibiotics for iGAS can help in the resolution of symptoms and good outcomes.
Collapse
Affiliation(s)
- Molla Imaduddin Ahmed
- Department of Paediatrics, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Rosalind V Saunders
- Department of Microbiology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Srini Bandi
- Department of Paediatrics, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| |
Collapse
|
3
|
Group A Streptococcal Infection During Pregnancy and the Postpartum Period. Nurs Womens Health 2020; 24:13-23. [PMID: 31917148 DOI: 10.1016/j.nwh.2019.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/12/2019] [Accepted: 11/01/2019] [Indexed: 12/20/2022]
Abstract
Group A Streptococcus, the causative organism for "childbed fever," continues to pose a threat to women during pregnancy and the postpartum period, despite advances in hygiene and the development of antibiotic therapy. This resilient bacterium has resurfaced with intensified virulence, and, for reasons not entirely clear, causes severe disease in some women. Sepsis and toxic shock syndrome caused by Group A Streptococcus contribute to the alarming rates of maternal morbidity and mortality in the United States. Early recognition of the subtle signs and symptoms of sepsis is critical to decrease the risk for mortality; however, early signs can be elusive during the perinatal period because of the physiologic changes of pregnancy. Care management requires a coordinated, collaborative, multidisciplinary team approach. Sepsis is a clinical emergency, and health care providers need to respond as a well-prepared team.
Collapse
|
4
|
Phuong LK, Bonetto C, Buttery J, Pernus YB, Chandler R, Felicetti P, Goldenthal KL, Kucuku M, Monaco G, Pahud B, Shulman ST, Top KA, Trotta F, Ulloa-Gutierrez R, Varricchio F, de Ferranti S, Newburger JW, Dahdah N, Singh S, Bonhoeffer J, Burgner D. Kawasaki disease and immunisation: A systematic review. Vaccine 2017; 35:1770-1779. [PMID: 28259442 DOI: 10.1016/j.vaccine.2016.09.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 02/09/2023]
|
5
|
Abstract
Group A streptococcus and Staphylococcus aureus are the most common bacterial etiologies of skin and soft tissue infections that range in virulence from very mild to limb/life threatening. Antibiotic coverage recommendations are varying and subject to controversy. Antibiotic resistance patterns are evolving with many different biochemical mechanisms. Rapid bacterial identification using mass spectrometry is on the horizon. Therapeutic considerations should include cost and adherence issues.
Collapse
|
6
|
Phuong LK, Bonetto C, Buttery J, Pernus YB, Chandler R, Goldenthal KL, Kucuku M, Monaco G, Pahud B, Shulman ST, Top KA, Ulloa-Gutierrez R, Varricchio F, de Ferranti S, Newburger JW, Dahdah N, Singh S, Bonhoeffer J, Burgner D. Kawasaki disease and immunisation: Standardised case definition & guidelines for data collection, analysis. Vaccine 2016; 34:6582-6596. [PMID: 27863715 DOI: 10.1016/j.vaccine.2016.09.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 01/24/2023]
Affiliation(s)
- Linny Kimly Phuong
- Monash Children's Hospital, Clayton, Melbourne, Australia; Royal Children's Hospital, Parkville, Victoria, Australia
| | | | - Jim Buttery
- Monash Children's Hospital, Clayton, Melbourne, Australia; Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | | | | | | | - Merita Kucuku
- Department of Vaccines Control, National Agency for Medicines and Medical Devices, Tirana, Albania
| | | | | | | | - Karina A Top
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | | | | | | - Surjit Singh
- Post Graduate Institute of Medical Education and Research (PGIMER) - Chandigarh, India
| | - Jan Bonhoeffer
- The Brighton Collaboration Foundation, Basel, Switzerland; University of Basel Children's Hospital, Basel, Switzerland.
| | - David Burgner
- Monash Children's Hospital, Clayton, Melbourne, Australia; Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, Monash University, Clayton, Victoria, Australia; Department of Paediatrics, Melbourne University, Parkville, Victoria, Australia
| |
Collapse
|
7
|
Barth DD, Engel ME, Whitelaw A, Alemseged A, Sadoh WE, Ali SKM, Sow SO, Dale J, Mayosi BM. Rationale and design of the African group A streptococcal infection registry: the AFROStrep study. BMJ Open 2016; 6:e010248. [PMID: 26916694 PMCID: PMC4769387 DOI: 10.1136/bmjopen-2015-010248] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Group A β-haemolytic Streptococcus (GAS), a Gram-positive bacterium, also known as Streptococcus pyogenes, causes pyoderma, pharyngitis and invasive disease. Repeated GAS infections may lead to autoimmune diseases such as acute post-streptococcal glomerulonephritis, acute rheumatic fever (ARF) and rheumatic heart disease (RHD). Invasive GAS (iGAS) disease is an important cause of mortality and morbidity worldwide. The burden of GAS infections is, however, unknown in Africa because of lack of surveillance systems. METHODS AND ANALYSIS The African group A streptococcal infection registry (the AFROStrep study) is a collaborative multicentre study of clinical, microbiological, epidemiological and molecular characteristics for GAS infection in Africa. The AFROStrep registry comprises two components: (1) active surveillance of GAS pharyngitis cases from sentinel primary care centres (non-iGAS) and (2) passive surveillance of iGAS disease from microbiology laboratories. Isolates will also be subjected to DNA isolation to allow for characterisation by molecular methods and cryopreservation for long-term storage. The AFROStrep study seeks to collect comprehensive data on GAS isolates in Africa. The biorepository will serve as a platform for vaccine development in Africa. ETHICS AND DISSEMINATION Ethics approval for the AFROStrep registry has been obtained from the Human Research Ethics Committee at the University of Cape Town (HREC/REF: R006/2015). Each recruiting site will seek ethics approval from their local ethics' committee. All participants will be required to provide consent for inclusion into the registry as well as for the storage of isolates and molecular investigations to be conducted thereon. Strict confidentiality will be applied throughout. Findings and updates will be disseminated to collaborators, researchers, health planners and colleagues through peer-reviewed journal articles, conference publications and proceedings.
Collapse
Affiliation(s)
- Dylan D Barth
- Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Mark E Engel
- Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Andrew Whitelaw
- Department of Microbiology, National Health Laboratory Service, Tygerberg Hospital and Stellenbosch University, Tygerberg, South Africa
| | - Abdissa Alemseged
- Department of Laboratory Sciences and Pathology, College of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Wilson E Sadoh
- Department of Child Health, School of Medicine, University of Benin and University of Benin Teaching Hospital, Benin City, Nigeria
| | - Sulafa K M Ali
- Department of Pediatrics and Child Health, Faculty of Medicine, University of Khartoum and Sudan Heart Institute, Khartoum, Sudan
| | - Samba O Sow
- Centre pour le Développement des Vaccins—Mali, Bamako, Mali
| | - James Dale
- Department of Medicine, Division of Infectious Diseases, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Bongani M Mayosi
- Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| |
Collapse
|