STREPTOCOCCAL TOXIC-SHOCK-SYNDROME COMPLICATING VARICELLA IN CHILDREN

The most common complication in children with varicella is cutaneous s uperimposed infection with pyogenic bacteria. Group A beta-hemolytic s treptococci, which are known to cause life-threatening infections in b oth previously healthy children and those with under lying diseases, a re the most frequently associated pathogens. A newly recognized diseas e, called streptococcal toxic shock syndrome, is associated with sever e morbidity and mortality. We report a 3-year-old boy with a diagnosis of this syndrome who presented with increasing fel er, vomiting, and lethargy 7 days after the development of a classic varicella skin lesi on. In spite of aggressive fluid supply, administration of inotropic a gents, and cardiopulmonary resuscitation, a rapidly deteriorating clin ical course led to death 4 hours after hospitalization. This is the fi rst report of this association in Taiwan. Pediatricians evaluating chi ldren with varicella must be mindful of the potential for Group X beta -hemolytic streptococcal infection.