Recurrent invasive group A streptococcal infection with four-limb amputation in an immunocompetent child. (30th July 2018)

• Record Type: Journal Article
• Authors: Gazzaz, Nour; Mailman, Timothy; Foster, Jennifer Ruth
• Is Part Of: BMJ case reports. Volume 2018
• Publication Date: 2018-07-30
• Subjects: drugs: infectious diseases -- bone and joint infections -- paediatric intensive care -- immunology; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2018-225292
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : We report a previously well paediatric patient with two distinct presentations of invasive group A streptococcus (GAS) infection resulting in significant morbidity. The first episode, following GAS pharyngitis, involved multiorgan dysfunction syndrome. This included cardiorespiratory and acute hepatorenal failure and purpura fulminans that eventually necessitated four-limb amputation. The second episode occurred 12 months later, from undetermined aetiology, and resulted in septic shock. Molecular analysis of the emm gene and PCR for Serum Opacity Factor revealed that the initial isolate was M Type 4 and sof gene positive while the second isolate was M Type 1 and sof gene negative. Immunological investigations, including CH50, quantitative IgA, IgM and IgG, and flow cytometry measuring lymphocyte subsets, and vaccine response to measles, mumps, rubella and pneumococcus were normal. This is the first report of recurrent bacteraemia from different strains of Streptococcus pyogenes infection in an apparently immunocompetent child.