[Severe streptococcal group A infection complicating varicella].
Varicella is a common viral infection which is generally benign in infancy and has a good outcome. It may sometimes be complicated by severe group A streptococcal superinfection.


METHODS
Three days after the beginning of varicella, a previously healthy 2-year-old girl presented with left leg pain, lameness and edema of all four limbs. Toxic shock syndrome occurred, due to beta-hemolytic group A Streptococcus grown from blood culture. Computerized tomography (CT) scan showed a mild effusion involving both hips. Cefotaxim was administered, but the week after magnetic resonance imaging (MRI) showed a necrotizing fasciitis and a lesion of the left leg leading to a patchy femoral diaphysis consistent with osteomyelitis. Joint aspirate culture did not grow. The left leg was immobilized in plaster for 6 weeks and the child was given cefotaxim and fosfomycin parenterally during 30 days, then followed by 45 days of oral amoxicillin. She recovered without sequelae.


CONCLUSIONS
Group A Streptococcus infection is a dangerous complication of varicella. It must be considered in case of any joint pain occurring during or just after this disease. The choice of the best treatment needs full collaboration between surgeons, radiologists and pediatricians.
Unité de réanimation pédiatrique, hôpital de Pontchaillou, Rennès, France.
D
D
Briard
P
P
Bétrémieux
V
V
Gandemer
M M
MM
Lucas
M
M
Chapuis
C
C
Tréguier
P
P
Pladys
D002439:Cefotaxime / Q000627:therapeutic use; D002644:Chickenpox / Q000150:complications*; D002675:Child, Preschool; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D005260:Female; D005578:Fosfomycin / Q000627:therapeutic use; D006801:Humans; D012772:Shock, Septic / Q000150:complications* / Q000188:drug therapy; D013290:Streptococcal Infections / Q000150:complications* / Q000188:drug therapy; D013297:Streptococcus pyogenes
D005578:Fosfomycin; D002439:Cefotaxime
Infection sévère à streptocoque du groupe A compliquant une varicelle.