title: [Management of severe invasive group A streptococcal infections].
abstract: The group A streptococcus (GAS) is the 5(th) responsible pathogen of invasive infections in children in France. These particularly severe diseases are dominated in children by soft tissue infection, isolated bacteremia but also osteoarthritis. Other complications are rare in France such as lung infections, necrotizing fasciitis (NF) and streptococcal toxic shock syndrome (STSS). More unusual localizations such as meningitis, neonatal infections, severe ear and throat and gastrointestinal infections and vascular disorders are also described. Based on published series, mortality ranging from 0-8 % of cases, is high but still lower than that observed in adults. Probabilistic antibiotherapy includes a β-lactam with anti-SGA but also anti-staphylococcal (predominantly methi-S in France) activity such as clavulanic acid- amoxicillin followed by amoxicillin as soon as identification of SGA is performed. The addition of an anti-toxin antibiotic such as clindamycin is recommended particularly in NF or STSS or clinical signs suggestive of toxin production by the SGA (rash, gastrointestinal signs, hemodynamic disorders). The use of intravenous polyvalent immunoglobulins must also be discussed in NF and STSS. In all cases surgery should be discussed. The prognosis of these potentially very severe infections is related to their early diagnosis and treatment. A better understanding of the pathophysiology of these infections may optimize their management but also their prevention.
authors.affiliation: Service de pédiatrie générale, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France; Université Paris Diderot, INSERM UMR 1123, Sorbonne-Paris-Cité, 46, rue Henri-Huchard, 75018 Paris, France. Electronic address: albert.faye@rdb.aphp.fr.
authors.forename: A
authors.initials: A
authors.lastname: Faye
authors.affiliation: Service de pédiatrie générale, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France; Université Paris Diderot, INSERM UMR 1123, Sorbonne-Paris-Cité, 46, rue Henri-Huchard, 75018 Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Lorrot
authors.affiliation: Laboratoire de microbiologie, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France; Université Paris-Diderot, INSERM UMR 722, Sorbonne-Paris-Cité, 46, rue Henri-Huchard, 75018 Paris, France.
authors.forename: Ph
authors.initials: P
authors.lastname: Bidet
authors.affiliation: Laboratoire de microbiologie, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France; Université Paris-Diderot, INSERM UMR 722, Sorbonne-Paris-Cité, 46, rue Henri-Huchard, 75018 Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Bonacorsi
authors.affiliation: Unité court séjour, petits nourrissons, service de néonatologie, CHI de Créteil, 40, avenue de Verdun, 94010 Créteil, France; Université Paris XII, 61, avenue du Général-de-Gaulle, 94010 Créteil, France; ACTIV (Association clinique et thérapeutique infantile du Val-de-Marne), 27, rue Inkermann, 94100 Saint-Maur-des-Fossés, France.
authors.forename: R
authors.initials: R
authors.lastname: Cohen
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003646:Debridement; D019115:Fasciitis, Necrotizing / Q000628:therapy; D006801:Humans; D006931:Hyperbaric Oxygenation; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D010102:Oxygen Inhalation Therapy; D012720:Severity of Illness Index; D018461:Soft Tissue Infections / Q000628:therapy; D013290:Streptococcal Infections / Q000628:therapy*; D013297:Streptococcus pyogenes
chemical_list: D000900:Anti-Bacterial Agents; D016756:Immunoglobulins, Intravenous