Invasive disease due to group A β-hemolytic streptococci:: Continued occurrence in children in North Carolina

Background. We have previously reported a significant increase beginning in the late 1980s in the incidence of invasive disease due to group A beta-hemolytic streptococci (GABS) in children admitted to our hospital. To determine subsequent trends in epidemiology, we have continued to monitor cases. Methods. We prospectively monitored cases of invasive disease due to CABS at Brenner Children's Hospital during the 5 1/2 years (July 1, 1990, to December 31, 1995) since our last report. Results. Twenty-five patients had GABS isolated from normally sterile sites. Their presentations were varied. One patient had necrotizing fasciitis and one had toxic shock-like syndrome. The one death was that of a newborn infant with sepsis and meningitis. The proportion of GABS infections associated with varicella was significantly greater during this period (7/25, 28%) than during the period 1983 to 1990 (1/22, 5%). Isolates were available for study from 24 patients. Serotypes were M1 (4), M3 (4), M6 (2), M12 (3), M22 (3), M75 (1) and M-nontypeable (7). The number of cases of invasive disease seen annually from 1983 through 1995 also is reviewed. Conclusions. The resurgence of invasive disease due to CABS in children noted in the late 1980s continues through the first half of the 1990s. The clinical manifestations are varied as are the causative M-types. As almost one third of cases in this series were associated with varicella infection, widespread use of the varicella vaccine may lead to a decrease in the incidence of invasive GABS disease.