Davies H D, Matlow A, Scriver S R, Schlievert P, Lovgren M, Talbot J A, Low D E
Division of Infectious Diseases, Hospital for Sick Children, Toronto, Ontario, Canada.
Pediatr Infect Dis J. 1994 Jan;13(1):49-56. doi: 10.1097/00006454-199401000-00011.
Since 1985 there have been worldwide reports of increases in severe invasive Group A streptococcal (IGAS) infections. We reviewed the charts of all children with IGAS infections (defined as isolation of Group A streptococcus from a normally sterile site) presenting to our institution over a 7-year period (January, 1985, to December, 1991) and the literature. Streptococcal toxic shock syndrome required hypotension and multisystem organ involvement. Twenty-four patients (mean age, 4.96 +/- 4.4 years) were identified with IGAS infection. One patient (presenting in 1989) met the criteria for probable streptococcal toxic shock syndrome and none died. Eight of 19 Group A streptococcal isolates tested were streptococcal pyrogenic exotoxin (SPE) A producers, most (90%) had the speC gene and all had the speB gene and produced the toxin. No M or T type predominated. The low rates of streptococcal toxic shock syndrome and fatalities among children with IGAS infection are consistent with other pediatric but not with adult series. The apparent differences in outcome of IGAS between children and adults were not explained by the virulence factors we examined and may warrant further investigation.
自1985年以来，全球范围内有关于严重侵袭性A组链球菌（IGAS）感染增加的报道。我们回顾了在7年期间（1985年1月至1991年12月）到我们机构就诊的所有IGAS感染儿童（定义为从通常无菌的部位分离出A组链球菌）的病历以及相关文献。链球菌中毒性休克综合征需要低血压和多系统器官受累。确定有24例患者（平均年龄4.96±4.4岁）患有IGAS感染。1例患者（1989年就诊）符合可能的链球菌中毒性休克综合征标准，且无死亡病例。在检测的19株A组链球菌分离株中，8株是产链球菌致热外毒素（SPE）A的菌株，大多数（90%）有speC基因，所有菌株都有speB基因并产生毒素。没有哪种M型或T型占主导。IGAS感染儿童中链球菌中毒性休克综合征和死亡率较低，这与其他儿科系列报道一致，但与成人系列报道不同。我们所检测的毒力因子无法解释儿童和成人IGAS感染结局的明显差异，这可能值得进一步研究。
