Severe group A streptococcal infections in a paediatric intensive care unit. (9th June 2014)

• Record Type: Journal Article
• Authors: Lithgow, Anna; Duke, Trevor; Steer, Andrew; Smeesters, Pierre Robert
• Is Part Of: Journal of paediatrics and child health. Volume 50:Number 9(2014:Sep.)
• Page Start: 687
• Page End: 692
• Publication Date: 2014-06-09
• Subjects: Children -- Health and hygiene -- Periodicals; Pediatrics -- Periodicals; 618.92
• DOI: 10.1111/jpc.12601
• Languages: English
• ISSNs: 1034-4810

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="jpc12601-sec-0001" sec-type="section"> <title>Aim</title> <p>To describe the clinical presentation, management and outcomes for children with invasive group A streptococcal (GAS) infection in a paediatric intensive care unit (PICU).</p> </sec> <sec id="jpc12601-sec-0002" sec-type="section"> <title>Methods</title> <p>We reviewed the clinical and laboratory records of patients admitted to a PICU in Melbourne with invasive GAS infection from April 2010 to April 2013. Outcomes recorded included survival, organ failure, need for extracorporeal support, renal replacement therapy and prolonged neuromuscular weakness.</p> </sec> <sec id="jpc12601-sec-0003" sec-type="section"> <title>Results</title> <p>Twelve cases of invasive GAS infection were identified. The most common clinical presentations were pneumonia (<italic>n</italic> = 5), bacteraemia with no septic focus (<italic>n</italic> = 4) and septic arthritis (<italic>n</italic> = 3). Necrotising fasciitis occurred in one patient and another patient presented with ischaemic lower limbs requiring amputation. Of the eight isolates with available <italic>emm</italic> typing results, the most common <italic>emm</italic> type was <italic>emm</italic>1 (<italic>n</italic> = 4) followed by <italic>emm</italic>4, 12 and 22. Nine patients had multi‐organ failure. Ten patients required mechanical ventilation for a median duration of 8 days. Nine patients required inotropic and/or vasopressor support and four patients extracorporeal membrane oxygenation support. Eleven patients survived. A prolonged period of neuromuscular weakness following the initial severe illness was common (<italic>n</italic> = 5), but most children returned to normal or near normal neurological function.</p> </sec> <sec id="jpc12601-sec-0004" sec-type="section"> <title>Conclusions</title> <p>Invasive GAS disease in children may cause severe multi‐organ failure with resultant prolonged intensive care stay and significant morbidity. However, a high rate of survival and return to normal functioning may be achieved with multi‐system intensive care support and multi‐disciplinary rehabilitation.</p> </sec> </abstract>