Invasive streptococcal group A infection in children: а review of the literature and a clinical case of the toxic shock syndrome and complicated community-acquired pneumonia in a child with lung malformation

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Abstract

Streptococcal group A  infection (SGAI) remains an important cause of morbidity and mortality in children. In the recent years, the spread of new highly virulent strains of Streptococcus pyogenes, capable of producing cytolysins and pyrogenic exotoxins (superantigens) has led to an increase in the number of severe forms of diseases with high mortality rates. Invasive infection can occur as necrotizing fasciitis, myositis, sepsis, toxic shock syndrome, scarlet fever, meningitis, myocarditis, and pneumonia. A variety of symptoms in patients with tonsillitis without purulent depositions or after a blunt trauma of soft tissues, such as vomiting, diarrhea, and abdominal pain, can mimic other diseases. The toxic shock syndrome with circulatory collapse, hypotension, acute renal failure, and coagulopathy may develop rapidly and be fatal if not recognized on time or if treated inadequately. Time-sensitive combined antimicrobial therapy and adequate fluid administration, before the bacteriological results are obtained, are important components of any successful treatment. The review describes the current epidemiological situation, diagnostic criteria and treatment strategies for invasive SGAI with an emphasis on the toxic shock syndrome. We present our own observation of SGAI in a 5-year-old child with tonsillitis without purulent depositions, with abdominal pain, typical erythematous rash with desquamation at typical time intervals, and a toxic shock syndrome and pneumonia complicated by pleuritis and pneumohydorotorax. The complications and duration of pneumonia were related to lung malformation (adenomatous cystic type 1 malformation of the lungs), which was newly detected at the time of the disease.

Conclusion: Due to global spread of SGAI, doctors should be alert to its severe manifestations.

About the authors

E. R. Meskina

Moscow Regional Research and Clinical Institute (MONIKI)

Author for correspondence.
Email: meskinaelena@rambler.ru

Elena R. Meskina – MD, PhD, Head of Сhildren's Infectious Disease Department.

61/2 Shchepkina ul., Moscow, 129110, tel.: +7 (916) 121 61 72

Россия

M. K. Khadisova

Moscow Regional Research and Clinical Institute (MONIKI)

Email: murzabekova.marina.1979@mail.ru

Marima K. Khadisova – MD, PhD, Research Fellow, Сhildren's Infectious Disease Department.

61/2 Shchepkina ul., Moscow, 129110, tel.: +7 (926) 264 93 30

Россия

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