Cowan M R, Primm P A, Scott S M, Abramo T J, Wiebe R A
Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas.
Ann Emerg Med. 1994 Apr;23(4):818-22. doi: 10.1016/s0196-0644(94)70320-5.
To alert practicing emergency physicians to an important and possibly increasing relationship between life-threatening group A beta-hemolytic streptococcal (GABHS) infections and children recovering from varicella.
A case series of six patients managed from January through March 1993.
A university-affiliated pediatric specialty emergency department.
Six previously healthy immunocompetent children between 1 and 5 years of age seen in our ED over a nine-week period.
Six children had onset of varicella two days to two weeks before developing a serious life-threatening GABHS infection. Children presented with clinical symptoms of invasive GABHS infection with bacteremia (one patient); streptococcal toxic shock syndrome with negative blood culture (two), pneumonia with pleural effusion and streptococcal toxic shock syndrome (one), pneumonia with pleural effusion (one), and pyomyositis of the thigh (one). Four of six patients required intensive care admissions and aggressive support of vital signs. All six survived.
Emergency physicians should be aware of the association between varicella and serious GABHS infections and be prepared to recognize and aggressively manage serious complications should they occur.
提醒急诊医生注意危及生命的A组β溶血性链球菌（GABHS）感染与水痘康复期儿童之间一种重要且可能日益增加的关联。
1993年1月至3月对6例患者进行的病例系列研究。
一所大学附属的儿科专科急诊科。
9周内在我们急诊科就诊的6名1至5岁既往健康、免疫功能正常的儿童。
6名儿童在发生严重的危及生命的GABHS感染前两天至两周出现水痘。患儿表现为侵袭性GABHS感染伴菌血症（1例）、血培养阴性的链球菌中毒性休克综合征（2例）、伴胸腔积液的肺炎和链球菌中毒性休克综合征（1例）、伴胸腔积液的肺炎（1例）以及大腿脓性肌炎（1例）。6例患者中有4例需要入住重症监护病房并积极支持生命体征。6例均存活。
急诊医生应意识到水痘与严重GABHS感染之间的关联，并准备好在严重并发症发生时予以识别并积极处理。
