Sophia Bellulo1, Julie Sommet2, Corinne Lévy3, Yves Gillet4, Laure Hees4, Mathie Lorrot5, Christèle Gras-Le-Guen6, Irina Craiu7, François Dubos8, Philippe Minodier9, Sandra Biscardi10, Marie-Aliette Dommergues11, Stéphane Béchet3, Philippe Bidet12, Corinne Alberti13, Robert Cohen14, Albert Faye5. 1. Department of Pediatrics, CHU Nord, Marseille, France. 2. INSERM, U 1123, ECEVE, CIC-EC 1426 Hôpital Robert Debré, Paris, France Department of General Pediatrics, CHU Robert Debré, Paris and University Paris Diderot, Sorbonne Paris Cité, Paris, France. 3. ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France. 4. ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France Department of Pediatrics, CHU Lyon-Bron and Lyon University, Hospices Civils de Lyon, Lyon, France. 5. INSERM, U 1123, ECEVE, CIC-EC 1426 Hôpital Robert Debré, Paris, France Department of General Pediatrics, CHU Robert Debré, Paris and University Paris Diderot, Sorbonne Paris Cité, Paris, France ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France. 6. ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France Department of Pediatrics, CHU Nantes and University of Nantes, Nantes, France. 7. ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France Department of Pediatrics, CHU Kremlin-Bicêtre, Le Kremlin Bicêtre, France. 8. ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France Pediatric Emergency Unit and Infectious Diseases, CHRU Lille and University of Lille, Lille, France. 9. Department of Pediatrics, CHU Nord, Marseille, France ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France. 10. ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France Department of Pediatrics, CHIC Créteil, Créteil, France. 11. ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France Department of Pediatrics, CH Versailles, Le Chesnay, France. 12. Department of General Pediatrics, CHU Robert Debré, Paris and University Paris Diderot, Sorbonne Paris Cité, Paris, France Department of Microbiology, CHU Robert Debré, Paris, France. 13. INSERM, U 1123, ECEVE, CIC-EC 1426 Hôpital Robert Debré, Paris, France. 14. ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France Unité Court Séjour, Petits Nourrissons, Service de Néonatologie, et Centre de Recherche Clinique, Centre Hospitalier Intercommunal de Créteil, Créteil, France.
Abstract
BACKGROUND: The incidence of invasive group A streptococcus (GAS) infections is increasing worldwide, whereas there has been a dramatic decrease in pneumococcal invasive diseases. Few data describing GAS pleural empyema in children are available. OBJECTIVE: To describe the clinical and microbiological features, management and outcome of GAS pleural empyema in children and compare them with those of pneumococcal empyema. DESIGN, SETTING AND PATIENTS: Fifty children admitted for GAS pleural empyema between January 2006 and May 2013 to 8 hospitals participating in a national pneumonia survey were included in a descriptive study and matched by age and centre with 50 children with pneumococcal empyema. RESULTS: The median age of the children with GAS pleural empyema was 2 (range 0.1-7.6) years. Eighteen children (36%) had at least one risk factor for invasive GAS infection (corticosteroid use and/or current varicella). On admission, 37 patients (74%) had signs of circulatory failure, and 31 (62%) had a rash. GAS was isolated from 49/50 pleural fluid samples and from one blood culture. The commonest GAS genotype was emm1 (n=17/22). Two children died (4%). Children with GAS empyema presented more frequently with a rash (p<0.01), signs of circulatory failure (p=0.01) and respiratory disorders (p=0.02) and with low leucocyte levels (p=0.04) than children with pneumococcal empyema. Intensive care unit admissions (p<0.01), drainage procedures (p=0.04) and short-term complications (p=0.01) were also more frequent in patients with GAS empyema. CONCLUSIONS: Pleural empyema following varicella or presenting with rash, signs of circulatory failure and leucopenia may be due to GAS. These features should prompt the addition to treatment of an antitoxin drug, such as clindamycin. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
BACKGROUND: The incidence of invasive group A streptococcus (GAS) infections is increasing worldwide, whereas there has been a dramatic decrease in pneumococcal invasive diseases. Few data describing GAS pleural empyema in children are available. OBJECTIVE: To describe the clinical and microbiological features, management and outcome of GAS pleural empyema in children and compare them with those of pneumococcal empyema. DESIGN, SETTING AND PATIENTS: Fifty children admitted for GAS pleural empyema between January 2006 and May 2013 to 8 hospitals participating in a national pneumonia survey were included in a descriptive study and matched by age and centre with 50 children with pneumococcal empyema. RESULTS: The median age of the children with GAS pleural empyema was 2 (range 0.1-7.6) years. Eighteen children (36%) had at least one risk factor for invasive GAS infection (corticosteroid use and/or current varicella). On admission, 37 patients (74%) had signs of circulatory failure, and 31 (62%) had a rash. GAS was isolated from 49/50 pleural fluid samples and from one blood culture. The commonest GAS genotype was emm1 (n=17/22). Two children died (4%). Children with GAS empyema presented more frequently with a rash (p<0.01), signs of circulatory failure (p=0.01) and respiratory disorders (p=0.02) and with low leucocyte levels (p=0.04) than children with pneumococcal empyema. Intensive care unit admissions (p<0.01), drainage procedures (p=0.04) and short-term complications (p=0.01) were also more frequent in patients with GAS empyema. CONCLUSIONS:Pleural empyema following varicella or presenting with rash, signs of circulatory failure and leucopenia may be due to GAS. These features should prompt the addition to treatment of an antitoxin drug, such as clindamycin. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Entities:
Keywords:
Streptococcus pneumoniae; group A streptococcus; pleural empyema
Authors: Teresa Del Rosal; María Belén Caminoa; Alba González-Guerrero; Iker Falces-Romero; María Pilar Romero-Gómez; Fernando Baquero-Artigao; Talía Sainz; Ana Méndez-Echevarría; Luis Escosa-García; Francisco Javier Aracil; Cristina Calvo Journal: Front Pediatr Date: 2020-12-15 Impact factor: 3.418