Invasive group A streptococcal infections in childhood: Experience in North Yorkshire

To characterise the nature of serious childhood GAS infections we reviewed the clinical and laboratory records of those patients < 20 years of age yielding the organism from blood culture over a 24-year period (1978–2002). Additionally, patients diagnosed with invasive GAS infection but without proven bacteraemia were studied for a concurrent 12-year period (1990–2002) in one of our two districts. The study showed that childhood infection accounted for 16/72 (22%) GAS bacteraemias during the period; 9 of those children (56%) were aged < 2 years, giving an annual incidence of 5.9 cases per 100,000 population in this early age group. The 12-year study showed that, in hospitalised children, invasive GAS infection without proven bacteraemia was at least two- to three-fold more common than this. Clinical manifestations resembled those found in infected adults, although varicella- and pharyngitis-associated infection, bone and joint infections and abscess appeared to predominate. There was a much lower case fatality rate in the children (4%) than in adults (30–47% in increasing age cohorts). Eight distinct T/M serotypes of GAS were found in infected children, and low M-number ‘respiratory’ strains predominated. There is a need to develop new methods for specific, rapid diagnosis of this dangerous infection.