Two cases and a review of Streptococcus pyogenes endocarditis in children
Bibliographic record
Abstract
BACKGROUND: Infective endocarditis is a rare diagnosis in pediatrics. Group A beta-hemolytic Streptococcus pyogenes is known to cause a range of type and severity of infections in childhood. However, S. pyogenes is a rarely described cause of endocarditis in children. This paper presents two cases of S. pyogenes endocarditis and the largest and most up-to-date review of cases previously reported in the literature. CASE PRESENTATION: Here we describe two pediatric cases of S. pyogenes endocarditis with associated toxic shock. Case 1 was a previously well Caucasian 6-year-old female who presented with sepsis. Case 2 was an 8-month-old South Asian female who presented with sepsis and pneumonia. We present a review of the literature since the beginning of the antibiotic era of this unusual cause of bacterial endocarditis in children. CONCLUSION: In addition to the two cases presented here, a total of 13 children have been reported since 1940 with endocarditis caused by S. pyogenes for which clinical details are available. Although few cases exist, literature review reveals a high mortality rate (27%) and the majority of patients who recovered had residual morbidities. We emphasize the importance of considering a diagnosis of endocarditis in cases of S. pyogenes sepsis or toxic shock in order to ensure early diagnosis and timely treatment, which are necessary for good outcomes. This information is relevant to both general and subspecialty pediatricians, especially emergency room and infectious disease physicians.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.010 | 0.007 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.001 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".