title: Characteristics of group A streptococcal bacteremia with comparison between children and adults.
abstract: This retrospective study aimed to compare the characteristics of group A streptococcal bacteremia in children and adults. A total of 76 (12 children and 64 adults) patients with group A streptococcal bacteremia treated from October 1995 through September 2000 at the Linko Chang Gung Memorial Hospital were included. The mean age was 47.6 years (range, 12 days-90 years). Forty-four (57.9%) patients had predisposing medical conditions. Malignant cancer (23.7%) and diabetes (22.4%) were the 2 most common conditions, which occurred only in adults. Two (16.7%) children had chickenpox associated with secondary group A streptococcal bacteremia. Skin and soft tissue infection (60.5%) was the most common clinical manifestation. The mortality rate related to group A streptococcal bacteremia was 25%. Twelve patients met the criteria of streptococcal toxic shock syndrome and 6 (50%) were children (p<0.05). Despite immediate and aggressive treatment, mortality due to streptococcal toxic shock syndrome was 66.7%. The incidence of streptococcal toxic shock syndrome was much higher in children (50%) than in adults (9.4%). Early diagnosis of invasive group A streptococcal infections and streptococcal toxic shock syndrome requires awareness of the presentations and a high level of suspicion. For fulminant group A streptococcal infection, a combination of a beta-lactam antibiotic plus clindamycin and/or adjuvant therapy with intravenous immunoglobulin is recommended.
authors.affiliation: Division of Pediatric Infectious Diseases, Chang Gung Children's Hospital, Taoyuan, Taiwan, ROC.
authors.forename: Y C
authors.initials: YC
authors.lastname: Huang
authors.forename: Y C
authors.initials: YC
authors.lastname: Huang
authors.forename: C H
authors.initials: CH
authors.lastname: Chiu
authors.forename: L Y
authors.initials: LY
authors.lastname: Chang
authors.forename: H S
authors.initials: HS
authors.lastname: Leu
authors.forename: T Y
authors.initials: TY
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000382:microbiology / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012772:Shock, Septic / Q000382:microbiology / Q000401:mortality*; D013290:Streptococcal Infections / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology*; D013297:Streptococcus pyogenes / Q000472:pathogenicity*