OUTBREAK OF GROUP-A STREPTOCOCCUS SEPTICEMIA IN CHILDREN - CLINICAL, EPIDEMIOLOGIC, AND MICROBIOLOGICAL CORRELATES

Objective.-To determine the epidemiologic, clinical, and microbiological features of group A streptococcus septicemia in children. Design. - A descriptive series of 34 cases over an 11 -year period from 1980 through 1990. Setting.-An academically affiliated tertiary-care pediatric hospital, the principal referral center for the state of Colorado and surrounding states. Participants.-Thirty-four patients with positive blood cultures for group A streptococcus (33 medical records were available). Main Outcome Measures.-Yearly incidence and clinical features of cases; microbiological features of isolated organisms. Results. -There was a significant increase (P = .01) in the incidence of group A streptococcus bacteremia over an 11-year period, with 14 (41 %) of these cases occurring in 1989 and 1990. Patients had a rapidly progressing illness, usually without preceding pharyngitis. The prominent M and T types were 1 (4) and 12 (4). Eleven (73%) of the 15 strains produced pyrogenic exotoxin B that significantly correlated with production of proteinase. Conclusion.-There appears to be an increase in group A streptococcus bacteremia in children that is associated with a strain phenotype that suggests a change in organism virulence.