SERIOUS GROUP-A BETA-HEMOLYTIC STREPTOCOCCAL INFECTIONS COMPLICATING VARICELLA

Study objective: To alert practicing emergency physicians to an import ant and possibly increasing relationship between life-threatening grou p A beta-hemolytic streptococcal (GABHS) infections and children recov ering from varicella. Design: A case series of six patients managed fr om January through March 1993.Setting: A university-affiliated pediatr ic specialty emergency department. Type of participants: Six previousl y healthy immunocompetent children between 1 and 5 years of age seen i n our ED over a nine-week period. Results: Six children had onset of v aricella two days to two weeks before developing a serious life-threat ening GABHS infection. Children presented with clinical symptoms of in vasive GABHS infection with bacteremia (one patient), streptococcal to xic shock syndrome with negative blood culture (two), pneumonia with p leural effusion and streptococcal toxic shock syndrome (one), pneumoni a with pleural effusion (one), and pyomyositis of the thigh (one). Fou r of six patients required intensive care admissions and aggressive su pport of vital signs. All six survived. Conclusion: Emergency physicia ns should be aware of the association between varicella and serious GA BHS infections and be prepared to recognize and aggressively manage se rious complications should they occur.