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Clinical characteristics of children with group A streptococcal toxic shock syndrome admitted to pediatric intensive care units

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Abstract

Streptococcal toxic shock syndrome (STSS) is a very rare and severe form of group A streptococcal infection whose clinical characteristics, therapy, morbidity, and mortality in children are not well known. Our objective was to describe the clinical characteristics of STSS in a series of children admitted to pediatric intensive care units (PICU). A multicenter, retrospective study of children with STSS admitted to 14 PICUs between January 1998 and December 2009 was conducted. Clinical information was obtained retrospectively by chart review. Data from 41 children were collected, 90% corresponding to the second half of the study period. Initial symptoms and signs were nonspecific. All patients developed shock and organ dysfunction, 78.0% developed coagulopathy, 70.7% neurologic dysfunction, and 68.3% respiratory failure. Rapid pharyngeal test for Streptococcus was positive in 78.0%. Initial leukocyte count was quite variable, with leukopenia present in 51.2% of patients and leukocytosis in 31.7%. Children were treated with antibiotics against group A Streptococcus (GAS), usually G penicillin or cephalosporin plus clindamycin. After a median PICU stay of 7 days (range 0–41), 65.8% of patients survived, 26.8% with sequelae. The cause of death of the 11 non-survivors was refractory shock and multi-organ failure. Conclusions: STSS is a very severe condition secondary to invasive GAS infection. It can occur at any age, but especially in young children. Due to the lack of specific symptoms and signs and its very rapid progression to shock and organ dysfunction, pediatricians and emergency physicians must be aware of this possibility and immediately initiate aggressive treatment when suspected.

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The authors declare no conflict of interest related to this work.

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Authors and Affiliations

  1. Pediatric Emergency and Critical Care Division, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, Spain

    Antonio Rodríguez-Nuñez & Silvia Dosil-Gallardo

  2. Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, Barcelona, Spain

    Iolanda Jordan

  3. UCI Pediatría, Hospital Clínico Universitario de Santiago de Compostela, A Choupana, s/n, 15706, Santiago de Compostela, Spain

    Antonio Rodríguez-Nuñez

Authors
  1. Antonio Rodríguez-Nuñez
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  2. Silvia Dosil-Gallardo
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  3. Iolanda Jordan
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Consortia

the ad hoc Streptococcal Toxic Shock Syndrome collaborative group of the Spanish Society of Pediatric Intensive Care

Corresponding author

Correspondence to Silvia Dosil-Gallardo.

Appendix

Appendix

Members of the ad hoc Streptococcal Toxic Shock Syndrome collaborative group of the Spanish Society of Pediatric Intensive Care:

  • - E. Sánchez Valderrábanos, J.D. López Castilla, C. Montero Valladares. Pediatric Intensive Care Unit. Hospital Infantil Universitario Virgen del Rocío. Sevilla.

  • - J. López-Herce Cid. Pediatric Intensive Care Unit. Hospital Gregorio Marañón. Madrid.

  • - J.D. Toledo Parreño, V. Modesto i Alapont. Pediatric Intensive Care Unit. Hospital Infantil La Fe. Valencia.

  • - C. Calvo Monge. Pediatric Intensive Care Unit. Hospital de Donostia. San Sebastián.

  • - J.A. Alonso Martín. Pediatric Intensive Care Unit. Hospital Virgen de la Salud. Toledo.

  • - P. Azcón González de Aguilar, J.L. Martínez Algar, C. González Hervás. Pediatric Intensive Care Unit. Hospital Virgen de las Nieves. Granada.

  • - A. Martín Torrecillas. Pediatric Intensive Care Unit. Hospital Costa del Sol. Marbella.

  • - S. Moralo García, P. Torres Tortosa. Pediatric Intensive Care Unit. Hospital Universitario Virgen de Arrixaca. Murcia.

  • - C. Rey Galán, A. Concha Torre. Pediatric Intensive Care Unit. Hospital Central de Asturias. Oviedo.

  • - T. Gili Bigatá, S. Sanchez Pérez. Pediatric Intensive Care Unit. Hospital de Sabadell. Corporación Parc Taulí.

  • - G. Milano Manso. Pediatric Intensive Care Unit. Hospital Materno-Infantil de Málaga.

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Rodríguez-Nuñez, A., Dosil-Gallardo, S., Jordan, I. et al. Clinical characteristics of children with group A streptococcal toxic shock syndrome admitted to pediatric intensive care units. Eur J Pediatr 170, 639–644 (2011). https://doi.org/10.1007/s00431-010-1337-x

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  • DOI: https://doi.org/10.1007/s00431-010-1337-x

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