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.
Eur J Pediatr. 2012 Nov;171(11):1589-98. doi: 10.1007/s00431-012-1694-8. Epub 2012 Feb 25.
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.
在过去的三十年中，儿童侵袭性 A 组链球菌感染（IGASI）的发病率呈上升趋势。感染类型的相对频率与成人中的 IGASI 明显不同，疾病的严重程度导致死亡率通常在 3.6%至 8.3%之间。携带特定毒力因子模式的emm1 型 A 组链球菌（GAS）亚克隆在 IGASI 患儿中广泛传播和流行，而 emm3 型 GAS 亚克隆则是最近出现的新兴基因型。然而，这些高毒力克隆在儿童中 IGASI 增加的作用仍存在争议。我们对 IGASI 发病机制的认识的最新进展强调，毒力因子产生的失调、个体易感性以及过度的细胞因子反应是导致儿童疾病严重程度的重要因素。目前正在研究针对 GAS 的安全有效的疫苗，预计未来 IGASI 的流行病学将会发生变化。IGASI 是一种复杂的感染，涉及败血症、中毒和免疫紊乱。由于与高度毒力细菌克隆传播相关的疾病的严重性，治疗必须对病原体及其毒素都有效。更普遍地说，在没有疫苗接种策略的情况下，负责败血症和中毒性疾病的毒力克隆的出现是儿科感染病学关注的问题。
