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Díaz Ruiz J, del Blanco Gómez I, Blanco Barrio A, Huidobro Labarga B, Merino Arribas JM. Osteomielitis de localización inusual. An Pediatr (Barc) 2007; 67:240-2. [PMID: 17785162 DOI: 10.1016/s1695-4033(07)70614-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Group A beta-hemolytic streptococcus (GAS) causes almost 10% of acute hematogenous osteomyelitis (AHOM). These entities are frequently located in long bones (femur, tibia and humerus), and only 6-8% of all AHOM are located in the pelvis. This uncommon localization delays diagnosis and can lead to inappropriate management, with negative effects on outcomes. We present the case of a 6-year-old boy with high fever, pain in the right hip and difficulty in walking due to pelvic AHOM and septic shock caused by GAS. We also provide a review of the literature.
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Affiliation(s)
- J Díaz Ruiz
- Servicio de Pediatría, Hospital General de Yagüe, Burgos, España.
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Borgen L, Haakonsen MO, Gudmundsen TE, Solheim D, Stensvold K. Acute osteomyelitis as a complication of varicella. Acta Radiol 2005; 46:652-6. [PMID: 16334850 DOI: 10.1080/02841850500215766] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Varicella is a common viral infection in childhood, and acute osteomyelitis is one of the rare but serious complications. We report two cases of osteomyelitis as a complication of varicella. The possibilities and limitations of the different imaging modalities are discussed, as well as imaging findings during the course of this condition.
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Affiliation(s)
- L Borgen
- Department of Radiology, Hospital of Buskerud, Drammen, Norway.
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Abstract
AIM To evaluate the course of group A streptococcal osteomyelitis associated with severe disease nowadays. METHODS Three consecutive cases of severe group A streptococcal disease with osteomyelitis in children that were documented in Beer Sheva, Israel are described in detail. RESULTS Two of the three cases were postvaricella. Early in the course of the disease, the presentation resembled that of severe cellulitis. All three patients had severe osteomyelitis and required surgery, and one patient developed chronic osteomyelitis. Sepsis was diagnosed in two cases. CONCLUSION Our cases are distinguishable from typical haematogenous staphylococcal osteomyelitis by the severe course and the extensive involvement of bone and soft tissues. The increase in severity of invasive group A streptococcal infections documented throughout the world could account for the difference between our complex cases and the previous reports.
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Affiliation(s)
- D Turner
- Pediatric Division. Shaare Zedek Medical Center, Jerusalem, Israel.
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Iglesias-Gamarra A, Mendez EA, Cuellar ML, Ponce de Leon JH, Jimenez C, Canãs C, Restrepo J, Peña M, Valle R, Espinoza LR. Poststreptococcal reactive arthritis in adults: long-term follow-up. Am J Med Sci 2001; 321:173-7. [PMID: 11269792 DOI: 10.1097/00000441-200103000-00003] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Poststreptococcal reactive arthritis (PSReA) is a recognized inflammatory articular syndrome that follows group A streptococcal infection in persons not fulfilling the Jones criteria for the diagnosis of acute rheumatic fever. Characteristic features include nonmigratory arthritis, lack of response to aspirin or nonsteroidal anti-inflammatory agents, and the presence of extra-articular manifestations, including vasculitis and glomerulonephritis. Whether or not patients with PSReA develop carditis is a point of contention. METHODS We analyzed the clinical features, laboratory findings, response to therapy, and outcome in patients diagnosed with PSReA between 1983 and 1998 and observed through April 2000. All patients were contacted, reexamined, and repeat antistreptolysin, rheumatoid factor, C3 and C4 complement components, and echocardiograms were performed. RESULTS Seventeen patients (4 men and 13 women) were included. All were of low socioeconomic status. All patients had acute severe arthritis that began shortly after a sore throat episode. Extra-articular involvement including tenosynovitis, vasculitis, and glomerulonephritis was relatively common. More importantly, none exhibited clinical and/or echocardiographic evidence of cardiac involvement. Longterm antibiotic therapy was not given. CONCLUSION Cardiac involvement did not occur in this group of patients with PSReA. Prolonged prophylactic antibiotic therapy may not be required for adult patients presenting with PSReA.
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Rotta AT, Grossi M, Fisher JE, Faden H. Delayed myonecrosis in a leukemic patient with invasive group A streptococcal disease. Pediatr Infect Dis J 1999; 18:564-7. [PMID: 10391196 DOI: 10.1097/00006454-199906000-00023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- A T Rotta
- Department of Pediatrics, The Children's Hospital of Buffalo and State University of New York School of Medicine, 14222, USA.
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Abstract
BACKGROUND Previous studies of occult bacteremia in febrile children have excluded patients with recognizable viral syndromes (RVS). There is little information in the literature regarding the rate of bacteremia in febrile children with RVS. OBJECTIVE To determine the rate of bacteremia in children 3 to 36 months of age with fever and RVS. METHODS We performed a retrospective analysis of all patients 3 to 36 months of age with a temperature > or =39 degrees C seen during a 5 1/2-year period in the Emergency Department of a tertiary care pediatric hospital. From this group those with a discharge diagnosis of croup, varicella, bronchiolitis or stomatitis and no apparent concomitant bacterial infection were considered to have an RVS. The rate of bacteremia was determined for those subjects with RVS who had blood cultures. RESULTS Of 21,216 patients 3 to 36 months of age with a temperature > or =39 degrees C, 1347 (6%) were diagnosed with an RVS. Blood cultures were obtained in 876 (65%) of RVS patients. Of patients who had blood cultures, true pathogens were found in only 2 of 876 (0.2%) subjects with RVS [95% confidence interval (CI) 0.01, 0.8%]. The rate of bacteremia was 1 of 411 (0.2%) for subjects with bronchiolitis, O of 249 (0%) for subjects with croup, O of 123 (0%) for subjects with stomatitis and 1 of 93 (1.1%) for subjects with varicella. CONCLUSIONS Highly febrile children 3 to 36 months of age with uncomplicated croup, bronchiolitis, varicella or stomatitis have a very low rate of bacteremia and need not have blood drawn for culture.
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Affiliation(s)
- D S Greenes
- Department of Pediatrics, Harvard Medical School, Children's Hospital, Boston, MA 02115, USA.
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Holzman RS. Prevention and treatment of life-threatening pediatric emergencies requiring anesthesia. ACTA ACUST UNITED AC 1998. [DOI: 10.1016/s0277-0326(98)80039-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Affiliation(s)
- J K Wenger
- Department of Pediatrics, Boston Medical Center, MA, USA
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McIver KS, Scott JR. Role of mga in growth phase regulation of virulence genes of the group A streptococcus. J Bacteriol 1997; 179:5178-87. [PMID: 9260962 PMCID: PMC179378 DOI: 10.1128/jb.179.16.5178-5187.1997] [Citation(s) in RCA: 117] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
To determine whether growth phase affects the expression of mga and other virulence-associated genes in the group A streptococcus (GAS), total RNA was isolated from the serotype M6 GAS strain JRS4 at different phases of growth and transcript levels were quantitated by hybridization with radiolabeled DNA probes. Expression of mga (which encodes a multiple gene regulator) and the Mga-regulated genes emm (which encodes M protein) and scpA (which encodes a complement C5a peptidase) was found to be maximal in exponential phase and shut off as the bacteria entered stationary phase, while the housekeeping genes recA and rpsL showed constant transcript levels over the same period of growth. Expression of mga from a foreign phage promoter in a mga-deleted GAS strain (JRS519) altered the wild-type growth phase-dependent transcription profile seen for emm and scpA, as well as for mga. Therefore, the temporal control of mga expression requires its upstream promoter region, and the subsequent growth phase regulation of emm and scpA is Mga dependent. A number of putative virulence genes in JRS4 were shown not to require Mga for their expression, although several exhibited growth phase-dependent regulation that was similar to mga, i.e., slo (which encodes streptolysin O) and plr (encoding the plasmin receptor/glyceraldehyde-3-phosphate dehydrogenase). Still others showed a markedly different pattern of expression (the genes for the superantigen toxins MF and SpeC). These results suggest the existence of complex levels of global regulation sensitive to growth phase that directly control the expression of virulence genes and mga in GAS.
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Affiliation(s)
- K S McIver
- Department of Microbiology and Immunology, Emory University Health Sciences Center, Atlanta, Georgia 30322, USA
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Héraud MC, Loriette Y, Grassano A, Magand F, Labbé A. [Severe streptococcal complications in varicella]. Arch Pediatr 1997; 4:430-2. [PMID: 9230992 DOI: 10.1016/s0929-693x(97)86668-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND An increase in the incidence of group A beta hemolytic streptococcal (GABHS) infections in children has been recently noted with a frequent association with varicella. CASE REPORTS Two children, 3 and 4.5 years old, developed varicella. The first one was febrile and presented a phlyctene on his left foot. Few hours after his admission, he presented a septic shock; GABHS was isolated from blood. Despite immediate adapted antibiotherapy, he developed a right tibial osteomyelitis with abscess. The second child also developed varicella and was hospitalized because of fever, bad general condition, right cervical adenitis and edema on the left wrist. Edema rapidly extended to the hand and upper arm. One purulent lesion was noted on the upper arm from whom Staphylococcus aureus and GABHS were isolated. Blood samples were sterile. The clinical course was favorable with adapted antibiotherapy. A cutaneous desquamation was observed on the 9th day and we concluded that it was a GABHS cellulitis. CONCLUSION These two cases confirm the recent report of increase in GABHS infections associated with varicella. Such complications must be looked for in patients with varicella remaining abnormally febrile and/or presenting unusual manifestations.
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Affiliation(s)
- M C Héraud
- Unité de réanimation et des maladies respiratoires, CHRU de Clermont-Ferrand, Hôtel-Dieu, France
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Abstract
Supraglottic infections are included among the more serious pediatric infections, although they are less common than other pediatric respiratory infections. Supraglottic infections include epiglottis (supraglottitis), retropharyngeal cellulitis, retropharyngeal abscess, and peritonsillar abscess. A high index of suspicion combined with rapid diagnosis and treatment are crucial to reducing the morbidity and mortality associated with these infections. A review of these infections, including diagnosis and treatment, is presented.
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Affiliation(s)
- S B Millan
- Family Practice Residency Program, University of Florida/Alachua General Hospital, Gainesville, Florida 32610-0217, USA
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Peterson CL, Mascola L, Chao SM, Lieberman JM, Arcinue EL, Blumberg DA, Kim KS, Kovacs A, Wong VK, Brunell PA. Children hospitalized for varicella: a prevaccine review. J Pediatr 1996; 129:529-36. [PMID: 8859259 DOI: 10.1016/s0022-3476(96)70117-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To describe varicella complications in healthy and previously ill children hospitalized for varicella and to explore trends in group A beta-hemolytic streptococcus complications of varicella. METHODS A retrospective record review of children hospitalized for varicella between January 1, 1990, and March 31, 1994, was conducted in nine large acute care hospitals in Los Angeles County, California. RESULTS We identified 574 children hospitalized for varicella in study hospitals during the 4.25-year study period (estimated risk of hospitalization, approximately 1 in 550 cases of varicella); 53% of the children were healthy before the onset of varicella and 47% were previously ill with underlying cancers or other chronic illnesses. Children were hospitalized for treatment of complications (n = 427, 74%) or for prophylactic antiviral therapy or observation (n = 147, 26%). Systems involved in complications included skin/soft tissue (45%), neurologic (18%), respiratory (14%), gastrointestinal (10%), and hematologic, renal, or hepatic (8% or less). The mean age of children with skin/soft tissue infections was 2.7 years (range < 1 to 16 years) compared with 4.7 years (< 1 to 18 years) for other complications. Children with skin/soft tissue and neurologic complications were more often previously healthy (p < 0.05), whereas those with respiratory complications were more often previously ill (p < 0.001). Hospitalizations for skin/soft tissue infections increased during the study period. The proportion of complications as a result of group A beta-hemolytic streptococcus infection increased from 4.7% before 1993 to 12.2% for the remainder of the study period (p = 0.02). CONCLUSIONS Prior health status was predictive of the type of complications experienced by children with varicella requiring hospitalization. Our data suggest a recent increase in skin/soft tissue complications of varicella requiring hospitalization and an increase in the proportion of complications related to group A beta-hemolytic streptococcus. Wide-scale vaccine use should reverse this trend and reduce the overall impact of varicella on both healthy and previously ill children.
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Affiliation(s)
- C L Peterson
- Division of Acute Communicable Disease Control, County of Los Angeles Department of Health Services, California 90012, USA
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Jorup-Rönström C, Hofling M, Lundberg C, Holm S. Streptococcal toxic shock syndrome in a postpartum woman. Case report and review of the literature. Infection 1996; 24:164-7. [PMID: 8740114 DOI: 10.1007/bf01713330] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A case of streptococcal toxic shock syndrome in a 29-year-old postpartum woman is described. The patient presented with hypotension, coagulation defects, adult respiratory distress syndrome and scarlet exanthema as a complication of hemolytic group A streptococcal endometritis. One hundred and twenty-two other cases of streptococcal toxic shock syndrome in the literature are reviewed and the criteria of the syndrome discussed. Streptococcal toxic shock syndrome seems to be increasing along with more frequent invasive streptococcal infections in several countries. It is therefore important to recognize and treat the infection as early as possible to minimize the risk of mortality.
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Vugia DJ, Peterson CL, Meyers HB, Kim KS, Arrieta A, Schlievert PM, Kaplan EL, Werner SB. Invasive group A streptococcal infections in children with varicella in Southern California. Pediatr Infect Dis J 1996; 15:146-50. [PMID: 8822288 DOI: 10.1097/00006454-199602000-00011] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe demographic and clinical features of invasive group A streptococcal (GAS) infections in children with varicella in Southern California in early 1994. METHODS From hospitals of Los Angeles and Orange Counties, children with invasive GAS infections after varicella between January 1 and April 8, 1994, were identified by hospital infection control nurses. Medical records of patients were reviewed, and any available GAS isolate was further tested. RESULTS Twenty-four cases were identified; 54% were male, 50% were Hispanic and the median age was 3 years (range, 0.5 to 8). Four cases died before hospitalization. The other 20 were hospitalized for a median of 10 days (range, 4 to 50): 14 presented with cellulitis (1 with concomitant epiglottitis), 2 with myositis/necrotizing fasciitis, 2 with pneumonia and 2 with bacteremia without apparent source. Five had evidence of multiorgan involvement including two patients fulfilling criteria of streptococcal toxic shock-like syndrome. Of 19 patients with blood cultures, 10 (53%) had GAS bacteremia. Onset of GAS infection was suggested, as a median, on Day 4 of varicella, with fever, vomiting and localized swelling being commonly reported. The mean maximum temperature on the day of admission was 39.4 degrees C (102.9 degrees F). Four GAS isolates were M1T1 and one was M3T3. Five isolates produced streptococcal pyrogenic exotoxins A and B. CONCLUSIONS Invasive GAS disease, including streptococcal toxic shock-like syndrome, is a serious complication of varicella. Physicians should be alert for the complication of GAS when fever and localized swelling or signs of cellulitis develop 3 days or more after the onset of varicella. Widespread use of varicella vaccine may decrease invasive GAS infections in this setting.
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Affiliation(s)
- D J Vugia
- Division of Communicable Disease Control, California Department of Health Services, Berkeley 94704, USA
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Li Volti S, Furnari ML, Garozzo R, Santangelo G, Mollica F. Acute post-streptococcal glomerulonephritis in an 8-month-old girl. Pediatr Nephrol 1993; 7:737-8. [PMID: 8130094 DOI: 10.1007/bf01213338] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We describe a middle class Sicilian girl who at 8 months of age suffered acute post-streptococcal glomerulonephritis documented by clinical hist a positive type 12 beta-haemolytic streptococcus throat culture, a raised anti-sterptolysin O titre and a low C3 rising to normal after 8 weeks
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Affiliation(s)
- S Li Volti
- Paediatric Clinic, University, Catania, Italy
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