Streptococcal toxic shock syndrome caused by Streptococcus pyogenes: a retrospective study of 15 pediatric cases
10.3760/cma.j.issn.0578-1310.2018.08.006
- VernacularTitle: 儿童化脓性链球菌致中毒性休克综合征15例
- Author:
Chunzhen HUA
1
;
Hui YU
2
;
Linhai YANG
;
Hongmei XU
;
Qin LYU
;
Hongping LU
;
Liyan LIU
;
Xuejun CHEN
;
Chuanqing WANG
Author Information
1. Division of Infectious Diseases, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
2. Division of Infectious Diseases, Children's Hospital of Fudan University, Shanghai 201102, China
- Publication Type:Journal Article
- Keywords:
Streptococcus pyogenes;
Child;
Streptococcal toxic shock syndrome
- From:
Chinese Journal of Pediatrics
2018;56(8):587-591
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To improve the understanding of clinical characteristics of streptococcal toxic shock syndrome (STSS) caused by Streptococcus pyogenes (S. pyogenes) in children.
Methods:A retrospective study was conducted to analyze the clinical data of STSS caused by S. pyogenes (culture-confirmed) in 7 tertiary hospitals during 2010—2017 in China. Clinical and laboratory data were collected by reviewing the medical records.
Results:Fifteen cases of STSS, including 9 males, were confirmed and the ages of the patients ranged from 6 months to 15 years, with median age of 3 years. All cases had the positive blood culture for S. pyogenes and only 3 cases had short course of β-lactam treatment before blood culture. Medical evaluation was initiated within (5.1±4.6) days after symptom onset. All patients had fever, and 13 patients had multiple organ dysfunction and 10 patients had disseminated intravascular coagulationl (DIC). Twelve cases had severe pneumonia with or without skin and (or) soft tissue infections. Underlying conditions included giant hemangioma of the skin in 2 patients and varicella in 1 patient. All isolated strains in 14 cases were sensitive to penicillin G, ceftriaxone/cefotaxime, vancomycin, but 12 and 13 isolates were resistant to clindamycin and erythromycin, respectively. Eight patients died, and 5 of them died within 24 hours after admission. One patient was lost to follow-up after intended discharge against medical advice.
Conclusion:STSS caused by S. pyogenes in children is a severe syndrome with rapid clinical progression and high mortality rate, and thus the pediatricians should be aware of STSS and immediately initiate aggressive treatment for the suspected cases.
