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In a message dated 12/10/99 12:33:29 PM Eastern Standard Time,
[log in to unmask] writes:
 
<<  had a 3 yo boy with varicella 3rd day and abdominal pain severe
< enough to awake him at night,after carefull evaluation at ER he was
< admitted to isolation ward where the diagnosis was Strep pharingitis<
< and septicemia >>
<
Hi Dr Alvarez,
I would like to provide you with some abstracts (and one citation without an
abstract).  Unfortunately, I do not at this time have access to the full
articles.  Perhaps some one else here on the list can provide you with them.
By the way, the MMWR means Medical Mortality Weekly Report and is published
by either the Centers for Disease Control in Atlanta Gerogia and/or the
National Institutes of Health in Bethseda Maryland.  I hope this will be of
some help to you.
Best regards,
Pete Speth, MD
Diplomat: American Board of Pathology
-------------------
MMWR Morb Mortal Wkly Rep 1997 Oct 10;46(40):944-8
Outbreak of invasive group A Streptococcus associated with varicella in a
childcare center -- Boston, Massachusetts, 1997.
             Group A Streptococcus (GAS) causes common childhood diseases
such as streptococcal pharyngitis and impetigo and can cause severe,
life-threatening invasive disease including streptococcal toxic-shock
syndrome and necrotizing fasciitis. Invasive GAS disease occurs when GAS
infects a normally sterile site. Clusters of invasive GAS infection
previously had not been reported among children in school or childcare
centers (CCCs). However, on February 13, 1997, the Boston Public Health
Commission received reports of cases of concurrent invasive GAS and varicella
infection among two of 14 children in the same CCC classroom. Because of the
potential for further spread of invasive disease, the Boston Public Health
Commission initiated an investigation of these cases. This report describes
the findings of the investigation, including risk factors for infection, and
recommended prevention measures. The findings indicate the potential for
widespread GAS infection and carriage in CCCs and suggest that, in this
outbreak, antecedent use of varicella vaccine would have prevented cases of
invasive GAS.
-------------------
Arch Pediatr 1997 Jun;4(6):583
[Varicella and invasive group A streptococcal infections].
[Article in French]
Chevallier C, Dumont C
Letter
Comments:
Comment in: Arch Pediatr 1998 Apr;5(4):458
-----------------
Pediatr Infect Dis J 1996 Feb;15(2):146-50
Invasive group A streptococcal infections in children with varicella in
Southern California.
Vugia DJ, Peterson CL, Meyers HB, Kim KS, Arrieta A, Schlievert PM, Kaplan
EL, Werner SB
Division of Communicable Disease Control, California Department of Health
Services, Berkeley 94704, USA.
               OBJECTIVE: To describe demographic and clinical features of
invasive group A streptococcal (GAS) infections in children with varicella in
Southern California in early 1994. METHODS: From hospitals of Los Angeles and
Orange Counties, children with invasive GAS infections after varicella
between January 1 and April 8, 1994, were identified by hospital infection
control nurses. Medical records of patients were reviewed, and any available
GAS isolate was further tested. RESULTS: Twenty-four cases were identified;
54% were male, 50% were Hispanic and the median age was 3 years (range, 0.5
to 8). Four cases died before hospitalization. The other 20 were hospitalized
for a median of 10 days (range, 4 to 50): 14 presented with cellulitis (1
with concomitant epiglottitis), 2 with myositis/necrotizing fasciitis, 2 with
pneumonia and 2 with bacteremia without apparent source. Five had evidence of
multiorgan involvement including two patients fulfilling criteria of
streptococcal toxic shock-like syndrome. Of 19 patients with blood cultures,
10 (53%) had GAS bacteremia. Onset of GAS infection was suggested, as a
median, on Day 4 of varicella, with fever, vomiting and localized swelling
being commonly reported. The mean maximum temperature on the day of admission
was 39.4 degrees C (102.9 degrees F). Four GAS isolates were M1T1 and one was
M3T3. Five isolates produced streptococcal pyrogenic exotoxins A and B.
CONCLUSIONS: Invasive GAS disease, including streptococcal toxic shock-like
syndrome, is a serious complication of varicella. Physicians should be alert
for the complication of GAS when fever and localized swelling or signs of
cellulitis develop 3 days or more after the onset of varicella. Widespread
use of varicella vaccine may decrease invasive GAS infections in this setting.
--------------------
Adv Pediatr Infect Dis 1999;14:129-45
Invasive group A streptococcal infections in children.
Davies HD, Schwartz B
University of Calgary, Alberta, Canada.
          Invasive group A streptococcal infections and STSS have increased
as causes of morbidity and mortality among children and adults. In children,
respiratory foci appear to be the most common, but skin and soft tissue
infection, particularly associated with varicella, also are common. Early
diagnosis requires awareness of the presenting features and a high index of
suspicion. Antimicrobial therapy that includes clindamycin, therapy with IVIG
for those with STSS, and surgical intervention for patients with necrotizing
fasciitis may improve outcome. Chemoprophylaxis should be considered among
household contacts of patients with severe group A streptococcal disease in
high-risk settings. Further studies are ongoing to evaluate the hypothesized
link of invasive group A streptococcal infection in children with varicella
and NSAID use, to better clarify the pathogenesis of STSS and necrotizing
fasciitis, and to better document the risk of secondary spread among close
contacts of case patients.
Publication Types:
Review
Review, tutorial
 
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