Two young brothers with invasive group A streptococcal infection

Middleton et al suggest a role for chemoprophylaxis of household contacts to reduce the burden of disease within the indigenous population of Australia, following a case of infant twins with invasive infections.1 A similar debate was raised in a regional Queensland hospital after two young white brothers (aged 3 and 5 years) were both diagnosed with invasive group A streptococcal (iGAS) infections. The brothers, who were admitted within 24 h of each other, presented with a short history of fevers, lethargy and joint pains. Initial diagnostic uncertainty was confounded by the family's recent 3-month travel history throughout South East Asia, returning to Australia only 5 days prior to presentation. Both children were initially commenced on IV Cefotaxime and subsequently grew Streptococcus pyogenes on blood culture. Coincidentally, both boys developed a right septic hip requiring several surgical interventions. The only potential risk factor identified (in both boys) relative to the transmission of iGAS was disruption of the skin secondary to mosquito bites sustained in Laos. No identifiable risk factors for the predilection for both boys to develop a right septic hip were noted. Radiology did not reveal any pre-existing hip dysplasia. Interestingly, the older brother had been diagnosed with right-sided Perthes disease while in Thailand approximately 2 months previously. The high transmissibility of iGAS indicates the potential role for chemoprophylaxis for close contacts; however, many countries including Australia have fallen short of this recommendation.1 Canadian guidelines suggest chemoprophylaxis be offered to all close contacts of a confirmed case of iGAS, including those exposed from 7 days pre-onset of symptoms in the case to 24 h after the initiation of antimicrobial therapy.2 Current UK guidelines also suggest if there are two or more cases of iGAS within a 30-day period, that household contacts should be issued chemoprophylaxis.3 Current Queensland Communicable Disease Control Guidance records iGAS as a notifiable condition; however, chemoprophylaxis is not routinely recommended.4 Several learning points were highlighted from this case: (i) initial diagnostic uncertainty is common in paediatric medicine and although a comprehensive travel history is important to consider the appropriate differential diagnoses, more common pathogens should not be discounted; (ii) the unusual nature of the almost identical clinical presentation (bacteraemia with right septic hip) is improbable, but not impossible; (iii) state-based education updates or protocols surrounding the provision of chemoprophylaxis could assist in reducing the burden of this disease among Australians.

Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.