INCREASED INCIDENCE AND SEVERITY OF STREPTOCOCCUS-PYOGENES BACTEREMIAIN YOUNG-CHILDREN

An increase in the incidence and severity of bacteremia caused by grou p A streptococci was noted in 1993 and 1994 in the Hadassah University Medical Center, Jerusalem. During the 6-year period 1987 to 1992, 12 children with group A streptococcal bacteremia were hospitalized, wher eas in 1993 and 1994 there were 17 patients, 5 of them with 1 each of the following severe clinical manifestations: meningitis and septic sh ock; streptococcal toxic shock syndrome; septic shock; pleural empyema ; and fatal outcome. Our 29 patients with group A streptococcal bacter emia were younger than those reported in the literature: 10 (35%) were <3 months of age; 17 (59%) were <1 year old. Most children were previ ously healthy and only 3 had an underlying immunodeficiency predisposi ng to infection (1 case each): leukemia; Di George syndrome; and conge nital nephrotic syndrome. Two children were recovering from varicella. The skin was the most common site of primary infection (16 of 29). Th e average white blood cell (WBC) count was 18 150 cells/mm(3) (range, 2200 to 34 200). The cases were not related epidemiologically and were caused by a variety of M-protein types. Polymerase chain reaction amp lification of the genes encoding exotoxins A (speA) and C (speC) was d one on 19 isolates and disclosed 2 strains positive for speA and 5 pos itive for speC. One of the speA-positive isolates was from the single patient with toxic shock syndrome.