title: Current insights in invasive group A streptococcal infections in pediatrics.
abstract: A rising incidence of invasive group A Streptococcus infections (IGASI) has been noted in children in the past three decades. The relative frequency of the infection types showed marked differences to IGASI in adults, and severity of the disease resulted in a mortality rate usually comprising between 3.6% and 8.3%. The emm1-type group A Streptococcus (GAS) subclone displaying a particular pattern of virulence factors was widely disseminated and prevalent in children with IGASI while the emm3-type GAS subclone appeared as a recent emerging genotype. However, the implication of these hypervirulent clones in the increase of IGASI in children is still controversial. Recent advances in our knowledge on pathogenesis of IGASI underlined that deregulation of virulence factor production, individual susceptibility, as well as exuberant cytokine response are important factors that may account for the severity of the disease in children. Future changes in IGASI epidemiology are awaited from current prospects for a safe and effective vaccine against GAS. IGASI are complex infections associating septic, toxic, and immunological disorders. Treatment has to be effective on both the etiologic agent and its toxins, due to the severity of the disease associated to the spread of highly virulent bacterial clones. More generally, emergence of virulent clones responsible for septic and toxic disease is a matter of concern in pediatric infectiology in the absence of vaccination strategy.
authors.affiliation: Service de Pédiatrie générale, Maladies Infectieuses, Immunologie Clinique, Centre Hospitalier Régional Universitaire de Montpellier, Hôpital Arnaud de Villeneuve, 371, Avenue du Doyen Gaston Giraud, 34295 Montpellier Cedex 5, France. a-filleron@chu-montpellier.fr
authors.forename: Anne
authors.initials: A
authors.lastname: Filleron
authors.forename: Eric
authors.initials: E
authors.lastname: Jeziorski
authors.forename: Anne-Laure
authors.initials: AL
authors.lastname: Michon
authors.forename: Michel
authors.initials: M
authors.lastname: Rodière
authors.forename: Hélène
authors.initials: H
authors.lastname: Marchandin
mesh_terms: D002648:Child; D024881:Drug Resistance, Bacterial; D014943:Global Health; D006801:Humans; D015994:Incidence; D012720:Severity of Illness Index; D013290:Streptococcal Infections / Q000453:epidemiology / Q000276:immunology / Q000382:microbiology / Q000517:prevention & control; D022541:Streptococcal Vaccines; D013297:Streptococcus pyogenes / Q000235:genetics / Q000276:immunology / Q000472:pathogenicity; D014774:Virulence
chemical_list: D022541:Streptococcal Vaccines