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Clinical, Epidemiologic, and Microbiological Correlates

Mary C. Wheeler, MA; Martha H. Roe; Edward L. Kaplan, MD; Patrick M. Schlievert, PhD; James K. Todd, MD

JAMA. 1991;266(4):533-537.

Abstract
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.

(JAMA. 1991;266:533-537)

Author Affiliations
From the Section of Epidemiology (Ms Wheeler) and the Departments of Pediatrics (Dr Todd) and Pathology (Ms Roe), The Children's Hospital of Denver (Colo); Departments of Pediatrics (Dr Todd) and Microbiology/Immunology (Dr Todd), University of Colorado School of Medicine, Denver; World Health Organization Collaborating Center for Reference and Research on Streptococci, Minneapolis, Minn (Dr Kaplan); and Departments of Pediatrics (Dr Kaplan) and Microbiology (Drs Kaplan and Schlievert), The University of Minnesota School of Medicine, Minneapolis.

Footnotes
Reprint requests to Section of Epidemiology, The Children's Hospital, 1056 E 19th Ave, Denver, CO 80218 (Ms Wheeler).

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