Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy.
Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy.
Ital J Pediatr. 2024 Sep 16;50(1):177. doi: 10.1186/s13052-024-01750-6.
Despite the worldwide increasing incidence of Group A Streptococcus (GAS) infections reported since December 2022, data on noninvasive GAS (nGAS) infections in the post COVID-19 era are limited. By a self-reported survey performed in an outpatient setting, we investigated the number and clinical features of GAS infections, the diagnostic work-up and the type of treatment utilized. In addition, the rate of influenza vaccination was evaluated.
In June 2023 family pediatricians involved in the study sent the survey to parents of patients aged 0-16 years. The survey included questions on GAS infections that occurred from January 1 to May 31, 2023.
Among 3580 children, 20.3% had a GAS infection (0,8% < 1 year, 16,4% 1-3 years, 42,3% 3-6 years, 26,5% 6-9 years, 11,4%, 9-12 years, and 2,6% 12-16 years). Symptoms reported were sore throat (76.9%), fever (75.2%), tonsillar exudate (25.2%), lymphadenopathy (21.8%), and scarlet fever (14.7%). A single patient was hospitalized due to GAS meningitis. Twenty four percent of children had more than one GAS infection. In this group, frequencies of symptoms reported in the first and in the following infection were similar, except for fever and scarlet fever which were less frequent during relapses. GAS was identified by rapid antigen detection test in 81.0% of children. Eighty-nine per cent of children were treated with antibiotics, mostly amoxicillin/clavulanate (40.4%) and amoxicillin (39.4%). Thirty four percent of children received influenza vaccine. No difference was observed among immunized and not immunized regarding the number and characteristics of GAS infection.
We reported a certain prevalence of nGAS infections in children, mainly those aged 3-6 years age, who were mostly characterized by a low score of symptoms, and in most of the cases diagnosed and treated using a microbiological test as confirmatory tool. In this new clinical setting, a national study would be useful to reach more significant data for the definition of a correct diagnosis and clinical management of nGAS infections in children. Moreover, it is important to improve flu vaccination campaign and coverage to protect children from coinfections that could worsen the disease and misdiagnose the etiology of pharyngitis.
尽管自 2022 年 12 月以来，全球范围内报道的 A 组链球菌（GAS）感染病例有所增加，但关于 COVID-19 后非侵袭性 GAS（nGAS）感染的数据有限。通过在门诊环境中进行的自我报告调查，我们调查了 GAS 感染的数量和临床特征、诊断工作以及所采用的治疗类型。此外，还评估了流感疫苗的接种率。
2023 年 6 月，参与研究的家庭儿科医生向年龄在 0-16 岁的患者的家长发送了调查。该调查包括 2023 年 1 月 1 日至 5 月 31 日期间发生的 GAS 感染问题。
在 3580 名儿童中，有 20.3%患有 GAS 感染（0，<1 岁 0.8%，1-3 岁 16.4%，3-6 岁 42.3%，6-9 岁 26.5%，9-12 岁 11.4%，12-16 岁 2.6%）。报告的症状包括咽痛（76.9%）、发热（75.2%）、扁桃体渗出物（25.2%）、淋巴结病（21.8%）和猩红热（14.7%）。仅有 1 例患者因 GAS 脑膜炎住院。24%的儿童患有多种 GAS 感染。在这一组中，首次感染和后续感染报告的症状频率相似，但发热和猩红热的频率较低。81.0%的儿童通过快速抗原检测试验鉴定出 GAS。89%的儿童接受了抗生素治疗，主要是阿莫西林/克拉维酸（40.4%）和阿莫西林（39.4%）。34%的儿童接受了流感疫苗接种。在 GAS 感染的数量和特征方面，免疫和未免疫的儿童之间没有差异。
我们报告了儿童中 nGAS 感染的一定流行率，主要发生在 3-6 岁年龄组，这些儿童的症状评分较低，大多数情况下通过微生物学检测作为确诊工具进行诊断和治疗。在这种新的临床环境下，进行一项全国性研究将有助于获得更有意义的数据，从而正确诊断和治疗儿童 nGAS 感染。此外，重要的是要加强流感疫苗接种运动和覆盖率，以保护儿童免受可能加重疾病和误诊咽炎病因的合并感染。
