title: [Streptococcus pyogenes infection in paediatrics: from pharyngotonsillitis to invasive infections].
abstract: BACKGROUND
  Streptococcus pyogenes or Group A Streptococci (GAS) cause many infections in infancy. Changes in its epidemiology have been described in recent years, including an increase in invasive infections (iGAS).
  
  
  METHODS
  A retrospective-descriptive study was conducted on children less than 15 years old, with GAS infections, in particular iGAS, and their complications from February 2004-April 2014.
  
  
  RESULTS
  A total of 2,192 positive cultures were obtained of which 92.7% were pharyngeal cultures. Twenty-nine patients were admitted to hospital: 4 with suppurative complications, 7 post-infective, 14 iGAS, and 4 probable iGAS cases. There were no differences in the frequency of GAS isolations/year. Non-invasive isolates were more frequent in winter and spring (P<.001), and 68.3% were in patients younger than 5 years. The incidence of iGAS was 2.1/100,000 children/year. There was no seasonality, and it was more frequent in younger children (P=.039). The most common diagnosis was pneumonia (6/14). Eight patients required intensive care. They were treated empirically with second or third-generation cephalosporin or with intravenous penicillin, and pneumonia required longer treatment times (P=.016). All GAS isolates were sensitive to penicillin, and 10.6% were resistant to erythromycin. The time spent in hospital was longer for iGAS than other cases (P=.028). No patients died.
  
  
  CONCLUSIONS
  Pharyngotonsillitis caused by GAS is common in childhood, and its incidence is increasing in children younger than 5 years. At the moment, post-infectious complications are rare. Invasive infections are the most severe forms of presentation, and are more common in younger children.
authors.affiliation: Unidad de Cuidados Intensivos de Pediatría, Hospital Clínico Universitario de Valencia, Valencia, España.
authors.forename: David
authors.initials: D
authors.lastname: Espadas Maciá
authors.affiliation: Unidad de Cuidados Intensivos de Pediatría, Hospital Clínico Universitario de Valencia, Valencia, España. Electronic address: eva.florm@gmail.com.
authors.forename: Eva María
authors.initials: EM
authors.lastname: Flor Macián
authors.affiliation: Departamento de Microbiología, Hospital Clínico Universitario de Valencia, Valencia, España.
authors.forename: Rafael
authors.initials: R
authors.lastname: Borrás
authors.affiliation: Departamento de Microbiología, Hospital Clínico Universitario de Valencia, Valencia, España.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Poujois Gisbert
authors.affiliation: Unidad de Cuidados Intensivos de Pediatría, Hospital Clínico Universitario de Valencia, Valencia, España.
authors.forename: Juan Ignacio
authors.initials: JI
authors.lastname: Muñoz Bonet
mesh_terms: D002675:Child, Preschool; D006801:Humans; D010612:Pharyngitis / Q000150:complications / Q000453:epidemiology / Q000382:microbiology*; D012189:Retrospective Studies; D013290:Streptococcal Infections / Q000150:complications / Q000453:epidemiology; D013297:Streptococcus pyogenes; D014069:Tonsillitis / Q000150:complications / Q000453:epidemiology / Q000382:microbiology
keywords: Acute pharyngeal tonsillitis; Faringoamigdalitis aguda; Infección invasiva; Invasive infection; Paediatrics; Pediatría; Streptococcus pyogenes