Group A Streptococcal Infections Are Associated With Increased Risk of Pediatric Neuropsychiatric Disorders

Introduction: Mortality associated with invasive group A streptococcal infections (iGAS) remains high among adults, with lower mortality in children. The added value of both clindamycin and immunoglobulins in such treatment is still controversial, as is the need for antibiotic secondary prophylaxis. It is unlikely that conclusive randomized clinical studies will ever definitively end these controversies.Materials and Methods: A clinical and experimental literature review was conducted in Pubmed, Cochrane, and lay literature to determine the benefit of adding clindamycin and immunoglobulins to β-lactams in the management of iGAS, as well as the need for secondary prophylaxis measures in close contacts.Results: This review includes two meta-analyses, two randomized controlled trials, four prospective studies, five retrospective studies, and microbiological studies. To reduce mortality and morbidity, it appears useful to add clindamycin to β-lactams in severe clinical presentations, including necrotizing fasciitis or streptococcal toxic shock syndrome, and immunoglobulins for the latter two presentations. The high risk of secondary infection in household contacts justifies the need of taking preventive measures.Conclusions: Both clinical studies and available experimental evidence suggest that adding clindamycin and immunoglobulins as adjunctive therapies in the management of invasive group A streptococcal infections may reduce mortality. Household contacts should be warned about the increased risk of secondary infection, and chemoprophylaxis may be considered in certain situations.

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Group A streptococcal infections. An old adversary reemerging with new tricks?

Archives of Dermatology ◽

10.1001/archderm.132.1.67 ◽

1996 ◽

Vol 132 (1) ◽

pp. 67-70 ◽

Cited By ~ 7

Author(s):

D. S. Feingold

Keyword(s):

Streptococcal Infections ◽

Group A

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Invasive Group A Streptococcal infections in children

Current Pediatric Reviews ◽

10.2174/1573396316666200704152246 ◽

2020 ◽

Vol 16 ◽

Author(s):

Molla Imaduddin Ahmed ◽

Rosalind V Saunders ◽

Srini Bandi

Keyword(s):

Early Diagnosis ◽

Management Practices ◽

Clinical Presentation ◽

Streptococcal Infections ◽

Invasive Group ◽

Children's Hospital ◽

Good Outcome ◽

Children’S Hospital ◽

Group A

: We reviewed the clinical presentation and management of children with Invasive group A streptococcal infections admitted to our tertiary Children’s Hospital in the last eight years. Our study highlighted the varied symptomatology and management practices in children with iGAS and showed that early diagnosis and prompt initiation of appropriate antibiotics for iGAS can help in resolution of symptoms and good outcome.

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Evaluating of the association between ABO blood groups and coronavirus disease 2019 (COVID-19) in Iraqi patients

Egyptian Journal of Medical Human Genetics ◽

10.1186/s43042-020-00097-x ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Ali H. Ad’hiah ◽

Risala H. Allami ◽

Raghdan H. Mohsin ◽

Maha H. Abdullah ◽

Ali J. R. AL-Sa’ady ◽

...

Keyword(s):

Blood Groups ◽

Abo Blood Groups ◽

Risk Of Death ◽

Increased Risk ◽

Fluorescence Probing ◽

Group A ◽

Risk Of Disease ◽

Novel Coronavirus ◽

Polymorphic System ◽

Made In

Abstract Background Susceptibility to the pandemic coronavirus disease 2019 (COVID-19) has recently been associated with ABO blood groups in patients of different ethnicities. This study sought to understand the genetic association of this polymorphic system with risk of disease in Iraqi patients. Two outcomes of COVID-19, recovery and death, were also explored. ABO blood groups were determined in 300 hospitalized COVID-19 Iraqi patients (159 under therapy, 104 recovered, and 37 deceased) and 595 healthy blood donors. The detection kit for 2019 novel coronavirus (2019-nCoV) RNA (PCR-Fluorescence Probing) was used in the diagnosis of disease. Results Mean age was significantly increased in patients compared to controls (49.8 ± 11.7 vs. 28.9 ± 6.6 years; p < 0.001). A similar observation was made in recovered (42.1 ± 10.4 vs. 28.9 ± 6.6 years; p < 0.001) and deceased (53.6 ± 9.7 vs. 28.9 ± 6.6 years; p < 0.001) cases. The mean age was also significantly increased in deceased cases compared to recovered cases (53.6 ± 9.7 vs. 42.1 ± 10.4 years; p < 0.001). There were gender-dependent differences in COVID-19 prevalence. The percentage of COVID-19 was higher in males than in females (all cases: 59.7 vs. 40.3%; recovered cases: 55.8 vs. 44.2%). Such male-gender preponderance was more pronounced in deceased cases (67.6 vs. 32.4%). Logistic regression analysis revealed that groups AB and B + AB were significantly associated with increased risk to develop COVID-19 (OR = 3.10; 95% CI 1.59–6.05; pc = 0.007 and OR = 2.16; 95% CI 1.28–3.63; pc = 0.028, respectively). No ABO-associated risk was observed in recovered cases. On the contrary, groups A (OR = 14.60; 95% CI 2.85–74.88; pc = 0.007), AB (OR = 12.92; 95% CI 2.11–79.29; pc = 0.042), A + AB (OR = 14.67; 95% CI 2.98–72.33; pc = 0.007), and A + B + AB (OR = 9.67; 95% CI 2.02–46.24; pc = 0.035) were associated with increased risk of death in deceased cases. Conclusions The findings of this study suggest that group AB may be a susceptibility biomarker for COVID-19, while group A may be associated with increased risk of death.

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Paediatric empyema: worsening disease severity and challenges identifying patients at increased risk of repeat intervention

Archives of Disease in Childhood ◽

10.1136/archdischild-2019-318219 ◽

2020 ◽

Vol 105 (9) ◽

pp. 886-890 ◽

Cited By ~ 1

Author(s):

Stuart Haggie ◽

Hasantha Gunasekera ◽

Chetan Pandit ◽

Hiran Selvadurai ◽

Paul Robinson ◽

...

Keyword(s):

Treatment Failure ◽

Initial Treatment ◽

Group A Streptococcus ◽

Thoracoscopic Surgery ◽

Tertiary Hospital ◽

Fibrinolytic Therapy ◽

Younger Age ◽

Increased Risk ◽

Group A ◽

Single Intervention

ObjectiveEmpyema is the most common complication of pneumonia. Primary interventions include chest drainage and fibrinolytic therapy (CDF) or video-assisted thoracoscopic surgery (VATS). We describe disease trends, clinical outcomes and factors associated with reintervention.Design/setting/patientsRetrospective cohort of paediatric empyema cases requiring drainage or surgical intervention, 2011–2018, admitted to a large Australian tertiary children’s hospital.ResultsDuring the study, the incidence of empyema increased from 1.7/1000 to 7.1/1000 admissions (p<0.001). We describe 192 cases (174 CDF and 18 VATS), median age 3.0 years (IQR 1–5), mean fever duration prior to intervention 6.2 days (SD ±3.3 days) and 50 (26%) cases admitted to PICU. PICU admission increased during the study from 18% to 34% (p<0.001). Bacteraemia occurred in 23/192 (12%) cases. A pathogen was detected in 131/192 (68%); Streptococcus pneumoniae 75/192 (39%), S. aureus 25/192 (13%) and group A streptococcus 13/192 (7%). Reintervention occurred in 49/174 (28%) and 1/18 (6%) following primary CDF and VATS. Comparing repeat intervention with single intervention cases, a continued fever postintervention increased the likelihood for a repeat intervention (OR 1.3 per day febrile; 95% CI 1.2 to 1.4, p<0.0001). Younger age, prolonged fever preintervention and previous antibiotic treatment were not associated with initial treatment failure (all p>0.05).ConclusionWe report increasing incidence and severity of empyema in a large tertiary hospital. One in four patients required a repeat intervention after CDF. Neither clinical variables at presentation nor early investigations were able to predict initial treatment failure.

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