title: Group A streptococcal osteomyelitis: severe presentation and course.
abstract: OBJECTIVE
  To evaluate the course of group A streptococcal osteomyelitis associated with severe disease nowadays.
  
  
  METHODS
  Three consecutive cases of severe group A streptococcal disease with osteomyelitis in children that were documented in Beer Sheva, Israel are described in detail.
  
  
  RESULTS
  Two of the three cases were postvaricella. Early in the course of the disease, the presentation resembled that of severe cellulitis. All three patients had severe osteomyelitis and required surgery, and one patient developed chronic osteomyelitis. Sepsis was diagnosed in two cases.
  
  
  CONCLUSIONS
  Our cases are distinguishable from typical haematogenous staphylococcal osteomyelitis by the severe course and the extensive involvement of bone and soft tissues. The increase in severity of invasive group A streptococcal infections documented throughout the world could account for the difference between our complex cases and the previous reports.
authors.affiliation: Pediatric Division. Shaare Zedek Medical Center, Jerusalem, Israel. turnerjd@zahav.net.il
authors.forename: D
authors.initials: D
authors.lastname: Turner
authors.forename: M
authors.initials: M
authors.lastname: Einhorn
mesh_terms: D002644:Chickenpox / Q000150:complications; D002908:Chronic Disease; D018450:Disease Progression; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010019:Osteomyelitis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology*; D010406:Penicillins / Q000627:therapeutic use; D012720:Severity of Illness Index; D013290:Streptococcal Infections / Q000150:complications*; D014057:Tomography, X-Ray Computed; D014457:Ulna / Q000000981:diagnostic imaging / Q000382:microbiology
chemical_list: D010406:Penicillins