(738) Severe Group A Streptococcal Infections in Pediatric Patients: Case Series and Review of Literature

Introduction: Invasive group A streptococcus disease (iGAS) is the presence of GAS in areas of the body that are typically sterile, such as the blood or CSF. Despite being relatively uncommon, iGAS infections pose a significant public health concern due to their high fatality rates. Viral infections have been recognized as factors that increase the risk of iGAS, especially in children. In 2022 there was a worldwide outbreak of iGAS infection. We describe 3 cases of severe iGAS infections admitted to our PICU. We review recent literature, highlighting their diverse clinical presentation, and treatment strategies and outcomes.

Methods: Published cases since 2016 were identified using PubMed database search terms: pediatric iGAS, bacteremia, and toxic shock. Title and abstracts of reports, cases, and research articles were reviewed for relevance.

Results: Case 1: 9-year-old girl with influenza A presented with periorbital cellulitis developing rapidly progressive multiorgan failure from septic shock secondary to GAS bacteremia resulting in death.
Case 2: 8-year-old boy presented with upper respiratory symptoms, and headaches with rhinovirus infection and streptococcal pharyngitis. He developed status epilepticus with GAS bacteremia. MRI brain and spine was consistent with acute disseminated encephalomyelitis (ADEM). His condition improved on antibiotics and steroids.
Case 3: 17-year-old boy presented with fever, sore throat, and a rash with streptococcal pharyngitis. and GAS bacteremia. He developed septic shock and subsequent myocarditis.
According to the CDC, 15 out of 34 cases in 2022 tested positive for at least one virus.

Conclusions: The incidence of viral infections prior to or during iGAS infections indicates that vaccination may help reduce the risk of iGAS. The diversity of clinical manifestations highlights the importance of early recognition and aggressive treatment. Further research is needed to explore the optimal management strategies for iGAS infections and to enhance public health surveillance for vaccination, early detection, and control.