APPARENT LOWER RATES OF STREPTOCOCCAL TOXIC SHOCK SYNDROME AND LOWER MORTALITY IN CHILDREN WITH INVASIVE GROUP-A STREPTOCOCCAL INFECTIONS COMPARED WITH ADULTS

Since 1985 there have been worldwide reports of increases in severe in vasive 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 institu tion over a 7-year period (January, 1985, to December, 1991) and the l iterature. 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 (presen ting in 1989) met the criteria for probable streptococcal toxic shock syndrome and none died. Eight of 19 Group A streptococcaI isolates tes ted 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 shoc k. syndrome and fatalities among children with IGAS infection are cons istent with other pediatric but not with adult series. The apparent di fferences in outcome of IGAS between children and adults were not expl ained by the virulence factors we examined and may warrant further inv estigation.