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Mediastinitis secondary to invasive infection by group A Streptococcus in Spain

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Abstract

This study describes 5 mediastinitis cases secondary to invasive group A Streptococcus (iGAS) disease in a recent outbreak in Spain. Among 398 iGAS cases between January 2019—March 2023, 5 (1.3%) were mediastinitis, 4 occurring in December 2022, all secondary to pneumonia or deep neck infection. We outline the clinical outcome with a review of the scarce pediatric literature.

  Conclusion: mediastinistis is a rare but severe complication of iGAS and a high level of suspicion is required to diagnose it.

What is Known:

• Group A Streptococcus can cause invasive and severe infections in children.

• Mediastinitis is a severe complication from some bacterial infections, mainly secondary due to deep-neck abscesses.

What is New:

• Mediastinitis is an unrecognized complication due to an invasive group A Streptococcus (iGAS) infection.

• In cases of a deep-neck abscess or complicated pneumonia a high clinical suspicion of iGAS mediastinitis is required, especially when the clinical course is not favorable.

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Data availability

The data presented in this study is available on request from the corresponding author.

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Acknowledgements

PEDGAS-Net group C. Calvo, Pediatric and Infectious Diseases Department, La Paz University Hospital, Institute for Health Research (IdiPAZ), Madrid, Spain, Biomedical Research Network Centre for Infectious Diseases (CIBERINFEC), Carlos III Health Institute, Madrid, Spain, Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain, Universidad Autónoma de Madrid, Madrid, Spain; I. Mellado-Sola I, Pediatric and Infectious Diseases Department, La Paz University Hospital, Institute for Health Research (IdiPAZ), Madrid, Spain; D. Grandioso, Microbiology, La Paz University Hospital, Madrid, Spain; J. Saavedra-Lozano, Pediatric Infectious Diseases Unit. Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Biomedical Research Network Centre for Infectious Diseases (CIBERINFEC), Carlos III Health Institute, Madrid, Spain, Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain, Hospital Institute of Health Research (IiSGM), Madrid, Spain, Universidad Complutense de Madrid, Madrid, Spain; D. Aguilera, Pediatric Infectious Diseases Unit. Department of Pediatrics, Hospital General Universitario Gregorio Marañón; E. Rincón, Pediatric Infectious Diseases Unit. Department of Pediatrics, Hospital General Universitario Gregorio Marañón; A. Jové, Pediatric Infectious Diseases Unit. Department of Pediatrics, Hospital General Universitario Gregorio Marañón; E. Cercenado, Pediatric Infectious Diseases Unit. Department of Pediatrics, Hospital General Universitario Gregorio Marañón; F.J. Sanz Santaeufemia, Hospital Niño Jesús, Madrid, Spain; M.J. Gónzalez, Hospital Niño Jesús, Madrid, Spain; E. Sánchez, Hospital Niño Jesús, Madrid, Spain; D. Blázquez, Hospital 12 de Octubre, Madrid, Spain; A. Manzanares, Hospital 12 de Octubre, Madrid, Spain; T. Reinoso, Hospital Infanta Sofía, Madrid, Spain; E. Cobo-Vázquez, Department of Pediatrics. Hospital Universitario Fundación de Alcorcón, Alcorcón, Madrid, Spain; G. Caro, Hospital Infanta Elena, Madrid, Spain; L. Lucía Figueroa, Hospital General de Villalba, Madrid, Spain; M. Llorente, Hospital Universitario del Sureste, Madrid, Spain; P. Galán, Hospital de Fuenlabrada, Madrid, Spain; A. Berzosa, Hospital Clínico, Madrid, Spain; M. Illán, Hospital Clínico, Madrid, Spain; K. Badillo, Hospital de Torrejón, Madrid, Spain; F.A. Montojo, Hospital Puerta de Hierro, Madrid, Spain; A. Álvarez, Hospital de Getafe, Madrid, Spain; B. Soto, Hospital de Getafe, Madrid, Spain; N. Cerdeira, Hospital Universitario del Henares, Madrid, Spain; C. Vázquez, Hospital Ramón y Cajal, Madrid, Spain; J. Carrasco, Hospital Son Espases, Baleares, Spain; M. Oltra, Hospital La Fe, Valencia, Spain; A. Piqueras, Hospital La Fe, Valencia, Spain; E. Montesinos, Consorcio Hospital General Universitario de Valencia, Valencia, Spain; N. Benavente, Hospital Clínico Universitario de Valencia, Valencia, Spain; C. Gavilán, Hospital Universitario San Juan, Alicante, Spain; M. Dapena, Hospital de Castellón, Castellón, Spain; E. Cervantes, Pediatrics and Infectious Diseases Department, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain; A. Menasalvas, Pediatrics and Infectious Diseases Department, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain; G. Yagüe, Pediatrics and Infectious Diseases Department, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain; C. Rex, Hospital Universitario Santa Lucía, Murcia, Spain; V. Rello, Hospital Vall D´Hebron, Barcelona, Spain; M. Lung, Hospital Vall D´Hebron, Barcelona, Spain; A. Gamell, Hospital San Joan De Déu, Barcelona, Spain; N. López, Hospital del Mar, Barcelona, Spain; B. Guarch, Hospital Josep Trueta, Girona, Spain; A. Hernández, Hospital Josep Trueta, Girona, Spain; B. Fernández, Hospital Germans Trias i Pujol, Barcelona, Spain; C. Rodrigo, Hospital Germans Trias i Pujol, Barcelona, Spain; O. Calavia, Hospital Joan XXIII, Tarragona, Spain, B. Pujol, Hospital General de Granollers, Barcelona, Spain; M. Ruíz, Hospital Universitari de Vic, Barcelona, Spain; L. García, Hospital de Mataró-Consorci Sanitari del Maresme, Barcelona, Spain; L. Falcón, Hospital Virgen del Rocío, Sevilla, Spain; L. Martínez, Complejo Hospitalario Torrecárdenas, Almería, Spain; M. Ibáñez, Complejo Hospitalario Torrecárdenas, Almería, Spain; L. Martín, Complejo Hospitalario Regional de Málaga, Málaga, Spain; B. Carazo, Complejo Hospitalario Regional de Málaga, Málaga, Spain; M. Sánchez-Códez, Hospital Universitario Puerta del Mar, Cádiz, Spain; A. Alonso, Hospital Universitario Puerta del Mar, Cádiz, Spain; B. Sevilla, Hospital San Cecilio, Granada, Spain; F. García, Hospital San Cecilio, Granada, Spain; B. Ruiz, Hospital Universitario Reina Sofía, Córdoba, Spain, D. López, H. Costa del Sol, Málaga, Spain; C. Calvo-Monge, Hospital Universitario Donostia, Gipúzkoa, Spain; E. Ortiz, H. de Basurto, Vizcaya, Spain; E. Garrote, H. de Basurto, Vizcaya, Spain; M. Itziar-Pocheville, Hospital de Cruces, Vizcaya, Spain; L. Calle, Hospital Central de Asturias, Asturias, Spain, I. Rivero, Hospital Clínico Universitario de Santiago de Compostela, A Coruña, Spain; F. Martinón, Hospital Clínico Universitario de Santiago de Compostela, A Coruña, Spain; B. Jiménez, Hospital Marqués de Valdecilla, Cantabria, Spain; E. Colino, Complejo Hospitalario Insular Materno Infantil, Las Palmas, Spain; J. Cuenca, Complejo Hospitalario Insular Materno Infantil, Las Palmas, Spain; M. Pareja, Hospital General de Albacete, Albacete, Spain; F. Camil-Olteanu, Hospital de Guadalajara, Guadalajara, Spain; E. del Castillo, Hospital Materno Infantil de Badajoz, Badajoz, Spain; V. Matías, Hospital Clínico de Valladolid, Valladolid, Spain.

Author information

Author notes

  1. I. Mellado-Sola and E. Cobo-Vazquez contributed equally to this work.

  2. J. Saavedra-Lozano and C. Calvo contributed equally to this work.

Authors and Affiliations

  1. Pediatric and Infectious Diseases Department, La Paz University Hospital, Institute for Health Research (IdiPAZ), Pº Castellana, 261, Madrid, 28046, Spain

    I. Mellado-Sola & C. Calvo

  2. Department of Pediatrics. Hospital, Universitario Fundación de Alcorcón, Alcorcón, Madrid, Spain

    E. Cobo-Vázquez

  3. Program in Medicine, Universidad Complutense de Madrid, Madrid, Spain

    E. Cobo-Vázquez

  4. Pediatric Intensive Care Unit, La Paz University Hospital, Madrid, Spain

    A. Calvo-Fernandez & B. Calderón-Llopis

  5. Pediatrics and Infectious Diseases Department, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain

    E. Cervantes

  6. Pediatric Intensive Care Unit, Ramón y Cajal University Hospital, Madrid, Spain

    A. Coca

  7. Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Madrid, Spain

    J. Saavedra-Lozano

  8. Biomedical Research Network Centre for Infectious Diseases (CIBERINFEC), Carlos III Health Institute, Madrid, Spain

    J. Saavedra-Lozano & C. Calvo

  9. Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain

    J. Saavedra-Lozano & C. Calvo

  10. Hospital Institute of Health Research (IiSGM), Madrid, Spain

    J. Saavedra-Lozano

  11. Universidad Complutense de Madrid, Madrid, Spain

    J. Saavedra-Lozano

  12. Universidad Autónoma de Madrid, Madrid, Spain

    C. Calvo

Authors
  1. I. Mellado-Sola
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  2. E. Cobo-Vázquez
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  3. A. Calvo-Fernandez
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  4. E. Cervantes
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  5. A. Coca
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  6. B. Calderón-Llopis
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  7. J. Saavedra-Lozano
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  8. C. Calvo
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Consortia

PedGAS-net group

  • C. Calvo
  • , I. Mellado-Sola
  • , D. Grandioso
  • , J. Saavedra-Lozano
  • , D. Aguilera
  • , E. Rincón
  • , A. Jové
  • , E. Cercenado
  • , F. J. Sanz Santaeufemia
  • , M. J. Gónzalez
  • , E. Sánchez
  • , D. Blázquez
  • , A. Manzanares
  • , T. Reinoso
  • , E. Cobo-Vázquez
  • , G. Caro
  • , L. Lucía Figueroa
  • , M. Llorente
  • , P. Galán
  • , A. Berzosa
  • , M. Illán
  • , K. Badillo
  • , F. A. Montojo
  • , A. Álvarez
  • , B. Soto
  • , N. Cerdeira
  • , C. Vázquez
  • , J. Carrasco
  • , M. Oltra
  • , A. Piqueras
  • , E. Montesinos
  • , N. Benavente
  • , C. Gavilán
  • , M. Dapena
  • , E. Cervantes
  • , A. Menasalvas
  • , G. Yagüe
  • , C. Rex
  • , V. Rello
  • , M. Lung
  • , A. Gamell
  • , N. López
  • , B. Guarch
  • , A. Hernández
  • , B. Fernández
  • , C. Rodrigo
  • , O. Calavia
  • , B. Pujol
  • , M. Ruíz
  • , L. García
  • , L. Falcón
  • , L. Martínez
  • , M. Ibáñez
  • , L. Martín
  • , B. Carazo
  • , M. Sánchez-Códez
  • , A. Alonso
  • , B. Sevilla
  • , F. García
  • , B. Ruiz
  • , D. López
  • , C. Calvo-Monge
  • , E. Ortiz
  • , E. Garrote
  • , M. Itziar-Pocheville
  • , L. Calle
  • , I. Rivero
  • , F. Martinón
  • , B. Jiménez
  • , E. Colino
  • , J. Cuenca
  • , M. Pareja
  • , F. Camil-Olteanu
  • , E. del Castillo
  •  & V. Matías

Contributions

Isabel Mellado-Sola, Elvira Cobo-Vázquez, Jesús Saavedra-Lozano and Cristina Calvo wrote the main manuscript text and table and contributed equally. Amaia Calvo-Fernández, Belén Calderón-Llopis, Ana Coca and Eloisa Cervantes provided cases' clinical, analytical and microbiological details. All authors reviewed the manuscript.

Corresponding author

Correspondence to I. Mellado-Sola.

Ethics declarations

Ethics approval

This study was designed following Declaration of Helsinki’s ethical principles for medical research and approved by the Ethics Committee of Gregorio Marañón Hospital, and the parents or guardians signed an informed consent prior to their inclusion in the study.

Competing interests

The authors declare no competing interests.

Additional information

Communicated by Tobias Tenenbaum

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PedGAS-net consortia representative: Jesús Saavedra-Lozano.

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Mellado-Sola, I., Cobo-Vázquez, E., Calvo-Fernandez, A. et al. Mediastinitis secondary to invasive infection by group A Streptococcus in Spain. Eur J Pediatr 183, 503–507 (2024). https://doi.org/10.1007/s00431-023-05288-3

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  • DOI: https://doi.org/10.1007/s00431-023-05288-3

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