Invasive Streptococcal Infection in Children: An Italian Case Series

Abstract

Since October 2022, alerts have spread from several countries about the increase in invasive group A streptococcal (iGAS) and scarlet fever cases affecting young children. We aim to analyze the epidemiology of GAS infections in the last 12 years in our hospital and identify the clinical features of invasive cases observed in 2023. We conducted a retrospective study enrolling children and adolescents hospitalized at our pediatric clinic from January to December 2023 for a definitive diagnosis of iGAS infection. Clinical, laboratory, and imaging data were collected and analyzed. Comparing 2016 and 2023, we observed a similar number of GAS infections (65 vs. 60 cases). Five children with iGAS infection were hospitalized between March and April 2023. The median age was five years. At admission, all patients showed tachycardia disproportionate to their body temperature. Vomiting was a recurrent symptom (80%). Laboratory tests mostly showed lymphopenia, hyponatremia, and high inflammatory markers. The number of pediatric iGAS cases significantly increased in 2023. Clinical (pre-school-aged children with high fever, unexplained tachycardia, and vomiting) and laboratory parameters (high procalcitonin levels, hyponatremia, and lymphopenia) could help identify and suspect a potential iGAS infection.

Keywords: children; group A streptococcus; invasive infection; pharyngitis; scarlet fever.

Figure 1

Trends of GAS infections from January 2012 to December 2023 in our pediatric clinic. Each color indicates a specific month of the year. The number of patients represents all GAS infections (including non-invasive and invasive cases) from 2012 to 2023. The total number of GAS infections corresponds to the height of the histogram and is shown at the top. The number of cases/month corresponds to the height of the month. The Y-axis (number of patients) is graduated every two patients. The X-axis shows the years from 2012 to 2023.