Changing pattern of clinical illness in children with group A streptococcal bacteremia.

OBJECTIVE

To test the hypothesis that bacteremia caused by group A streptococci (gas) has become more common and the presentation of the infection more severe in the Izaak Walton Killam Hospital for Children during the past decade.

DESIGN

Retrospective analysis by laboratory log and chart review.

SETTING

A pediatric teaching hospital providing primary and tertiary care.

RESULTS

There was no difference in the frequency of detection of gas bacteremia between the two periods studied (1980 to 1988 and 1988 to 1991). However, severe gas infection with deep tissue invasion was more common in the last three-year period (77% versus 11%, P=0.01). Severity, as measured by length of hospital stay, was also greater in the recent group (17.9 days versus 3.3 days, P=0.03). A recent group of four children was identified with a unique clinical syndrome of rash, severe myalgias, hyperesthesia, and refusal to bear weight.

CONCLUSION

The number of cases of severe gas disease has increased in the past several years, and gas infection should be included in the differential diagnosis of seriously ill children, gas infection must be managed aggressively with vigilance for additional deep tissue involvement, even while on appropriate antimicrobial therapy.