GROUP-A STREPTOCOCCAL NECROTIZING FASCIITIS COMPLICATING PRIMARY VARICELLA - A SERIES OF 14 PATIENTS

We retrospectively reviewed the clinical course of group A Streptococc us necrotizing fasciitis complicating primary varicella in children ad mitted to Children's Hospital and Medical Center, Seattle, WA, during a 18-month period. The potential benefit of various therapeutic interv entions was examined, Fourteen children ages 6 months to 10 years were treated for group A Streptococcus necrotizing fasciitis as a complica tion of primary varicella. Eight patients experienced a delay in initi al diagnosis as a result of nonspecific, early clinical findings of ne crotizing fasciitis. Each patient underwent surgical exploration with fasciotomies and debridement. Initial antibiotic therapy was broad spe ctrum and included clindamycin. Hyperbaric oxygen therapy for as many as 6 treatments was used as adjunctively therapy in 12 patients, with subjective benefit in 6 patients. All 14 patients were discharged home with good function and no long term sequelae. This potentially fatal bacterial infection of the deep fascial layers requires early recognit ion by primary care physicians and an intensive, multidisciplinary the rapeutic approach, including thorough surgical debridement and appropr iate antibiotic therapy.