SEVERE INVASIVE GROUP-A STREPTOCOCCAL INFECTIONS - A SUBJECT REVIEW

The course of severe invasive group A beta-hemolytic streptococcal (GA BHS) infections is often precipitous, requiring prompt diagnosis and r apid initiation of appropriate therapy. Therefore, physicians must hav e a high index of suspicion of this disease, particularly in patients at increased risk (eg, those with varicella or diabetes mellitus). Alt hough a relationship between the use of nonsteroidal antiinflammatory drugs and severe invasive GABHS infections has been suggested, at pres ent data on which to base a clinical derision about the use or restric tion of nonsteroidal antiinflammatory drugs in children with varicella are insufficient. When necrotizing fasciitis is suspected, prompt sur gical drainage, debridement, fasciotomy, or amputation often is necess ary. Many experts recommend intravenously administered penicillin G an d clindamycin for the treatment of invasive GABHS infections on the ba sis of animal studies. Some evidence exists that intravenous immunoglo bulin given in addition to appropriate antimicrobial and surgical ther apy may be beneficial. Although chemoprophylaxis for household contact s of persons with invasive GABHS infections has been considered by som e experts, the limited available data indicate that the risk of second ary cases is low (2.9 per 1000) and data about the effectiveness of an y drug are insufficient to make recommendations. Because of the low ri sk of secondary cases of invasive GABHS infections in schools or child care facilities, chemoprophylaxis is not indicated in these settings. Routine immunization of all healthy children against varicella is rec ommended and is an effective means to decrease the risk of invasive GA BHS infections.