Vugia D J, Peterson C L, Meyers H B, Kim K S, Arrieta A, Schlievert P M, Kaplan E L, Werner S B
Division of Communicable Disease Control, California Department of Health Services, Berkeley 94704, USA.
Pediatr Infect Dis J. 1996 Feb;15(2):146-50. doi: 10.1097/00006454-199602000-00011.
To describe demographic and clinical features of invasive group A streptococcal (GAS) infections in children with varicella in Southern California in early 1994.
From hospitals of Los Angeles and Orange Counties, children with invasive GAS infections after varicella between January 1 and April 8, 1994, were identified by hospital infection control nurses. Medical records of patients were reviewed, and any available GAS isolate was further tested.
Twenty-four cases were identified; 54% were male, 50% were Hispanic and the median age was 3 years (range, 0.5 to 8). Four cases died before hospitalization. The other 20 were hospitalized for a median of 10 days (range, 4 to 50): 14 presented with cellulitis (1 with concomitant epiglottitis), 2 with myositis/necrotizing fasciitis, 2 with pneumonia and 2 with bacteremia without apparent source. Five had evidence of multiorgan involvement including two patients fulfilling criteria of streptococcal toxic shock-like syndrome. Of 19 patients with blood cultures, 10 (53%) had GAS bacteremia. Onset of GAS infection was suggested, as a median, on Day 4 of varicella, with fever, vomiting and localized swelling being commonly reported. The mean maximum temperature on the day of admission was 39.4 degrees C (102.9 degrees F). Four GAS isolates were M1T1 and one was M3T3. Five isolates produced streptococcal pyrogenic exotoxins A and B.
Invasive GAS disease, including streptococcal toxic shock-like syndrome, is a serious complication of varicella. Physicians should be alert for the complication of GAS when fever and localized swelling or signs of cellulitis develop 3 days or more after the onset of varicella. Widespread use of varicella vaccine may decrease invasive GAS infections in this setting.
描述1994年初南加州水痘患儿侵袭性A组链球菌（GAS）感染的人口统计学和临床特征。
洛杉矶和奥兰治县医院的医院感染控制护士识别出1994年1月1日至4月8日期间水痘后发生侵袭性GAS感染的儿童。查阅患者的病历，并对任何可用的GAS分离株进行进一步检测。
共识别出24例病例；54%为男性，50%为西班牙裔，中位年龄为3岁（范围为0.5至8岁）。4例在住院前死亡。其他20例住院中位时间为10天（范围为4至50天）：14例表现为蜂窝织炎（1例伴有会厌炎），2例表现为肌炎/坏死性筋膜炎，2例表现为肺炎，2例表现为无明显来源的菌血症。5例有多个器官受累的证据，其中2例符合链球菌中毒性休克样综合征的标准。在19例血培养患者中，10例（53%）有GAS菌血症。GAS感染的发病时间中位数为水痘发病后第4天，常见症状为发热、呕吐和局部肿胀。入院当天的平均最高体温为39.4℃（102.9℉）。4株GAS分离株为M1T1型，1株为M3T3型。5株分离株产生链球菌致热外毒素A和B。
侵袭性GAS疾病，包括链球菌中毒性休克样综合征，是水痘的严重并发症。当水痘发病3天或更长时间后出现发热、局部肿胀或蜂窝织炎迹象时，医生应警惕GAS并发症。广泛使用水痘疫苗可能会减少这种情况下的侵袭性GAS感染。
