Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA.
Section of Infectious Diseases, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado, USA.
J Pediatric Infect Dis Soc. 2023 Oct 28;12(10):540-548. doi: 10.1093/jpids/piad080.
In the fall of 2022, we observed a sharp rise in pediatric Invasive Group A Streptococcus (iGAS) hospitalizations in Colorado. We compared the epidemiology, clinical features, and patient outcomes in this outbreak to prior years.
Between October 2022 and April 2023, we prospectively identified and reviewed iGAS cases in hospitalized pediatric patients at Children's Hospital Colorado. Using laboratory specimen records, we also retrospectively compared the number of patients with sterile site GAS-positive cultures across three time periods: pre-COVID-19 (January 2015-March 2020), height of COVID-19 pandemic (April 2020-September 2022), and outbreak (October 2022-April 2023).
Among 96 prospectively identified iGAS cases, median age was 5.7 years old; 66% were male, 70% previously healthy, 39% required critical care, and four patients died. Almost 60% had associated respiratory viral symptoms, 10% had toxic shock syndrome, and 4% had necrotizing fasciitis. Leukopenia, bandemia, and higher C-reactive protein values were laboratory findings associated with need for critical care. There were significantly more cases during the outbreak (9.9/month outbreak vs 3.9/month pre-pandemic vs 1.3/month pandemic), including more cases with pneumonia (28% outbreak vs 15% pre-pandemic vs 0% pandemic) and multifocal disease (17% outbreak vs 3% pre-pandemic vs 0% pandemic), P < .001 for all.
Outbreak case numbers were almost triple the pre-pandemic baseline. The high percentage of cases with associated viral symptoms suggests a link to coinciding surges in respiratory viruses during this time. Invasive GAS can be severe and evolve rapidly; clinical and laboratory features may help in earlier identification of critically ill children.
2022 年秋季，我们观察到科罗拉多州儿童侵袭性 A 组链球菌（iGAS）住院人数急剧上升。我们将此次暴发的流行病学、临床特征和患者结局与前几年进行了比较。
在 2022 年 10 月至 2023 年 4 月期间，我们前瞻性地确定并回顾了科罗拉多儿童医院住院的儿科 iGAS 病例。我们还使用实验室标本记录，回顾性地比较了三个时间段（新冠疫情前[2015 年 1 月至 2020 年 3 月]、新冠疫情高峰期[2020 年 4 月至 2022 年 9 月]和暴发期[2022 年 10 月至 2023 年 4 月]）中无菌部位 GAS 阳性培养的患者数量。
在 96 例前瞻性确定的 iGAS 病例中，中位年龄为 5.7 岁；66%为男性，70%既往健康，39%需要重症监护，4 例患者死亡。近 60%的患者有相关呼吸道病毒症状，10%有中毒性休克综合征，4%有坏死性筋膜炎。白细胞减少、带血、C 反应蛋白升高是需要重症监护的实验室发现。暴发期间的病例数显著增加（暴发期间 9.9/月，新冠疫情前 3.9/月，新冠疫情高峰期 1.3/月），包括更多的肺炎病例（暴发期间 28%，新冠疫情前 15%，新冠疫情高峰期 0%）和多灶性疾病（暴发期间 17%，新冠疫情前 3%，新冠疫情高峰期 0%），所有组间差异均有统计学意义（P 值均<0.001）。
暴发期间的病例数几乎是新冠疫情前基线的三倍。与相关病毒症状相关的高比例病例表明，在此期间与呼吸道病毒同时激增有关。侵袭性 GAS 可能很严重且迅速演变；临床和实验室特征可能有助于更早识别重症儿童。
