title: Outbreak of group A streptococcus septicemia in children. Clinical, epidemiologic, and microbiological correlates.
abstract: OBJECTIVE
  To determine the epidemiologic, clinical, and microbiological features of group A streptococcus septicemia in children.
  
  
  METHODS
  A descriptive series of 34 cases over an 11-year period from 1980 through 1990.
  
  
  METHODS
  An academically affiliated tertiary-care pediatric hospital, the principal referral center for the state of Colorado and surrounding states.
  
  
  METHODS
  Thirty-four patients with positive blood cultures for group A streptococcus (33 medical records were available).
  
  
  METHODS
  Yearly incidence and clinical features of cases; microbiological features of isolated organisms.
  
  
  RESULTS
  There was a significant increase (P = .01) in the incidence of group A streptococcus bacteremia over an 11-year period, with 14 (41%) of these cases occurring in 1989 and 1990. Patients had a rapidly progressing illness, usually without preceding pharyngitis. The prominent M and T types were 1 (4) and 12 (4). Eleven (73%) of the 15 strains produced pyrogenic exotoxin B that significantly correlated with production of proteinase.
  
  
  CONCLUSIONS
  There appears to be an increase in group A streptococcus bacteremia in children that is associated with a strain phenotype that suggests a change in organism virulence.
authors.affiliation: Section of Epidemiology, Children's Hospital, Denver, CO 80218.
authors.forename: M C
authors.initials: MC
authors.lastname: Wheeler
authors.forename: M H
authors.initials: MH
authors.lastname: Roe
authors.forename: E L
authors.initials: EL
authors.lastname: Kaplan
authors.forename: P M
authors.initials: PM
authors.lastname: Schlievert
authors.forename: J K
authors.initials: JK
authors.lastname: Todd
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003120:Colorado / Q000453:epidemiology; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology*; D013290:Streptococcal Infections / Q000453:epidemiology*; D013297:Streptococcus pyogenes / Q000472:pathogenicity; D014774:Virulence