Invasive group A streptococcal infections as a consequence of coexisting or previous viral infection in the post-COVID-19 pandemic period

Background

Group A Streptococci (GAS) may cause infections of the pharynx and soft tissues and invasive infections in children (iGAS). A significant increase in severe iGAS infections has been reported in Europe since the fall of 2022.

Objectives

This retrospective study aims to analyse clinical data of children with invasive and non-invasive GAS infections in the post-COVID-19 pandemic era, searching for predisposing factors to developing invasive infections.

Methods

History and clinical data of patients hospitalised due to or with coexisting GAS infections were analysed. iGAS and non-iGAS infections were compared.

Results

The cohort comprised 45 children (median age 7 years). 31(69 %) children developed iGAS infections - sepsis with toxic shock syndrome (TSS) (4 children-13 %), deep soft tissue infections (3–10 %), meningitis (2–6 %), pneumonia (2–6 %) or respiratory tract infections – sinusitis or otitis (4–12 %). iGAS children developed complications more frequently (100 % vs 21 %, p < 0.0001) and required prolonged treatment (median 15 vs 10 days, p = 0.0001). Preceding or coexisting viral infections were more common in iGAS children (87 % vs 14 %; p < 0.0001). CRP and PCT were significantly higher in the iGAS group (median 17.95 vs 3.97 mg/dl, p = 0.0002; 6.8 vs 0.05 ng/ml, p = 0.0001, respectively). The multiple logistic regression revealed that preceding or coexisting viral infections and the rise in CRP level increased the risk of iGAS infections. The CRP cut-off > 14.94 mg/dl showed 68.2 % sensitivity (CI 45.13–86.14 %) and 100 % specificity (69.15–100 %).

Conclusion

Our study shows increased incidence and severity of GAS infections among hospitalised children. Previous or coexisting viral infections and CRP with cut-off > 14.94 mg/dl were significant risk factors.