title: When should clinicians suspect group A streptococcus empyema in children? A multicentre case-control study in French tertiary care centres.
abstract: BACKGROUND
  The incidence of invasive group A streptococcus (GAS) infections is increasing worldwide, whereas there has been a dramatic decrease in pneumococcal invasive diseases. Few data describing GAS pleural empyema in children are available.
  
  
  OBJECTIVE
  To describe the clinical and microbiological features, management and outcome of GAS pleural empyema in children and compare them with those of pneumococcal empyema.
  
  
  METHODS
  Fifty children admitted for GAS pleural empyema between January 2006 and May 2013 to 8 hospitals participating in a national pneumonia survey were included in a descriptive study and matched by age and centre with 50 children with pneumococcal empyema.
  
  
  RESULTS
  The median age of the children with GAS pleural empyema was 2 (range 0.1-7.6) years. Eighteen children (36%) had at least one risk factor for invasive GAS infection (corticosteroid use and/or current varicella). On admission, 37 patients (74%) had signs of circulatory failure, and 31 (62%) had a rash. GAS was isolated from 49/50 pleural fluid samples and from one blood culture. The commonest GAS genotype was emm1 (n=17/22). Two children died (4%). Children with GAS empyema presented more frequently with a rash (p<0.01), signs of circulatory failure (p=0.01) and respiratory disorders (p=0.02) and with low leucocyte levels (p=0.04) than children with pneumococcal empyema. Intensive care unit admissions (p<0.01), drainage procedures (p=0.04) and short-term complications (p=0.01) were also more frequent in patients with GAS empyema.
  
  
  CONCLUSIONS
  Pleural empyema following varicella or presenting with rash, signs of circulatory failure and leucopenia may be due to GAS. These features should prompt the addition to treatment of an antitoxin drug, such as clindamycin.
authors.affiliation: Department of Pediatrics, CHU Nord, Marseille, France.
authors.forename: Sophia
authors.initials: S
authors.lastname: Bellulo
authors.affiliation: INSERM, U 1123, ECEVE, CIC-EC 1426 Hôpital Robert Debré, Paris, France Department of General Pediatrics, CHU Robert Debré, Paris and University Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Sommet
authors.affiliation: ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France.
authors.forename: Corinne
authors.initials: C
authors.lastname: Lévy
authors.affiliation: ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France Department of Pediatrics, CHU Lyon-Bron and Lyon University, Hospices Civils de Lyon, Lyon, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Gillet
authors.affiliation: ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France Department of Pediatrics, CHU Lyon-Bron and Lyon University, Hospices Civils de Lyon, Lyon, France.
authors.forename: Laure
authors.initials: L
authors.lastname: Hees
authors.affiliation: INSERM, U 1123, ECEVE, CIC-EC 1426 Hôpital Robert Debré, Paris, France Department of General Pediatrics, CHU Robert Debré, Paris and University Paris Diderot, Sorbonne Paris Cité, Paris, France ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France.
authors.forename: Mathie
authors.initials: M
authors.lastname: Lorrot
authors.affiliation: ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France Department of Pediatrics, CHU Nantes and University of Nantes, Nantes, France.
authors.forename: Christèle
authors.initials: C
authors.lastname: Gras-Le-Guen
authors.affiliation: ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France Department of Pediatrics, CHU Kremlin-Bicêtre, Le Kremlin Bicêtre, France.
authors.forename: Irina
authors.initials: I
authors.lastname: Craiu
authors.affiliation: ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France Pediatric Emergency Unit and Infectious Diseases, CHRU Lille and University of Lille, Lille, France.
authors.forename: François
authors.initials: F
authors.lastname: Dubos
authors.affiliation: Department of Pediatrics, CHU Nord, Marseille, France ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Minodier
authors.affiliation: ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France Department of Pediatrics, CHIC Créteil, Créteil, France.
authors.forename: Sandra
authors.initials: S
authors.lastname: Biscardi
authors.affiliation: ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France Department of Pediatrics, CH Versailles, Le Chesnay, France.
authors.forename: Marie-Aliette
authors.initials: MA
authors.lastname: Dommergues
authors.affiliation: ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Béchet
authors.affiliation: Department of General Pediatrics, CHU Robert Debré, Paris and University Paris Diderot, Sorbonne Paris Cité, Paris, France Department of Microbiology, CHU Robert Debré, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Bidet
authors.affiliation: INSERM, U 1123, ECEVE, CIC-EC 1426 Hôpital Robert Debré, Paris, France.
authors.forename: Corinne
authors.initials: C
authors.lastname: Alberti
authors.affiliation: ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France Unité Court Séjour, Petits Nourrissons, Service de Néonatologie, et Centre de Recherche Clinique, Centre Hospitalier Intercommunal de Créteil, Créteil, France.
authors.forename: Robert
authors.initials: R
authors.lastname: Cohen
authors.affiliation: INSERM, U 1123, ECEVE, CIC-EC 1426 Hôpital Robert Debré, Paris, France Department of General Pediatrics, CHU Robert Debré, Paris and University Paris Diderot, Sorbonne Paris Cité, Paris, France ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France.
authors.forename: Albert
authors.initials: A
authors.lastname: Faye
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D016022:Case-Control Studies; D002644:Chickenpox / Q000150:complications; D002648:Child; D002675:Child, Preschool; D042241:Early Diagnosis; D016724:Empyema, Pleural / Q000175:diagnosis* / Q000453:epidemiology / Q000382:microbiology; D005260:Female; D005602:France; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D011008:Pneumococcal Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D013296:Streptococcus pneumoniae; D062606:Tertiary Care Centers / Q000706:statistics & numerical data
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal
keywords: Streptococcus pneumoniae; group A streptococcus; pleural empyema