Bellulo Sophia, Sommet Julie, Lévy Corinne, Gillet Yves, Hees Laure, Lorrot Mathie, Gras-Le-Guen Christèle, Craiu Irina, Dubos François, Minodier Philippe, Biscardi Sandra, Dommergues Marie-Aliette, Béchet Stéphane, Bidet Philippe, Alberti Corinne, Cohen Robert, Faye Albert
Department of Pediatrics, CHU Nord, Marseille, France.
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.
Arch Dis Child. 2016 Aug;101(8):731-5. doi: 10.1136/archdischild-2015-309831. Epub 2016 Apr 12.
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.
To describe the clinical and microbiological features, management and outcome of GAS pleural empyema in children and compare them with those of pneumococcal empyema.
DESIGN, SETTING AND PATIENTS: 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.
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.
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.
侵袭性A组链球菌（GAS）感染的发病率在全球范围内呈上升趋势，而肺炎球菌侵袭性疾病的发病率则显著下降。关于儿童GAS胸膜腔积脓的资料很少。
描述儿童GAS胸膜腔积脓的临床和微生物学特征、治疗及转归，并与肺炎球菌性胸膜腔积脓进行比较。
设计、研究地点和患者：2006年1月至2013年5月期间，8家参与全国肺炎调查的医院收治的50例GAS胸膜腔积脓患儿纳入一项描述性研究，并按年龄和中心与50例肺炎球菌性胸膜腔积脓患儿进行匹配。
GAS胸膜腔积脓患儿的中位年龄为2岁（范围0.1 - 7.6岁）。18例患儿（36%）至少有一项侵袭性GAS感染的危险因素（使用皮质类固醇和/或当前患水痘）。入院时，37例患者（74%）有循环衰竭体征，31例（62%）有皮疹。49/50份胸腔积液样本和1份血培养中分离出GAS。最常见的GAS基因型为emm1（n = 17/22）。2例患儿死亡（4%）。与肺炎球菌性胸膜腔积脓患儿相比，GAS胸膜腔积脓患儿出现皮疹（p < 0.01）、循环衰竭体征（p = 0.01）、呼吸障碍（p = 0.02）及白细胞水平低（p = 0.04）的情况更为常见。GAS胸膜腔积脓患者入住重症监护病房（p < 0.01）、进行引流操作（p = 0.04）及短期并发症（p = 0.01）也更为频繁。
水痘后或出现皮疹、循环衰竭体征和白细胞减少的胸膜腔积脓可能由GAS引起。这些特征应促使在治疗中加用抗毒素药物，如克林霉素。
