The many faces of Group A Streptococcal infections, case-series of invasive infections in children in Iceland
Elín Óla Klemenzdóttir1,2
Arna Ýr Karelsdóttir3
Valtýr Stefánsson Thors1,2
1Childrens Hospital Hringurinn, National University Hospital of Iceland, Reykjavík, 2National University Hospital of Iceland, Reykjavík, 3Faculty of Medicine, Department of Health Sciences, University of Iceland, Reykjavík.
Correspondence: Elín Óla Klemenzdóttir, elino@landspitali.is
Key words: GAS, abscess, meningitis, fasciitis, toxic shock syndrome.
In recent months the incedence of invasive group A streptococcal infections (Streptococcus pyogenes) has increased worldwide. In the Children's Hospital Iceland 20 such cases were admitted during a four month period, until which time the avarage was one or two children admitted with an invasive GAS infection per year. To demonstrate the variability in the presentation of these invasive infections four cases were chosen for discussion in this case-series. Empyema with toxic shock syndrome, meningitis, orbital abscess and fascitis of the leg are reviewed.
Figure 1. A chest X-ray taken upon admission to ICU. Pleural fluid can be seen alongside the left lung along with atelectasis in the basal left lung.
Figure 2. The wound with mild erythema around it. Picture taken the night before presentation in the Pediatric ER.
Figure 3. Widespread redness around the leg and foot along with blistering. Picture taken on the day of surgery, approximately one and a half day after the onset of erythema.
Figure 4. An MRI of the leg showing thick hyperdense signal from the fascia and inflammation.
Figure 5. A CT scan from the day of admisson showing an abscess medially in the left orbit and
sinusitis.
Figure 6. Lymphadenitis and soft tissue inflammation of the neck.
Figure 7. Mastidis, redness and swelling behind a protruding ear.