65 Severe Soft Tissue Infection with Group a Streptococcus (GAS) in Children
Bibliographic record
Abstract
To describe the demography, clinical features, risk factors and epidemiology of severe soft tissue infection with GAS in children. Retrospective chart review of cases of severe soft tissue infections admitted at a tertiary care pediatric hospital between 1/1/1993 and 30/7/2003. Cases were included if GAS was isolated in blood culture or local site and they were diagnosed with necrotizing fasciitis (NF), myositis, severe cellulitis or abcesses by surgery, pathology, radiology and/or high clinical suspicion. Children with immunosuppression or neoplasia were excluded. Among 32 identified cases, 43.8 % were male, 34.4% were not caucasian and 78.1% were previously healthy. Distribution in time is shown in figure 1. Median age was 4.5 years (range, 2 month to 15.2 years). Forty-one per cent (13/32) had NF, 43.8% (14/32) abcesses, 12.5% (4/32) severe cellulitis and 3.1% (1/32) myositis. More than one site was infected in 6 cases. Varicella was present in 68.8% of cases. Eight fulfilled criteria of streptococcal toxic shock syndrome (STSS); 7 of them had NF. Nine were admitted in PICU. Number of cases of severe GAS infection per year. On admission, median temperature was 39.2°C, median leukocytes count was 16.0×109/L with a median of 77% of neutrophils. Creatinine kinase level (CK) was abnormal in 30.8% (4/13) of the NF cases. Only 12.5% were bacteremic. Twenty-one cases were surgically debrided. Median time of surgery from onset of local signs was 3 days (range, 1 to 11). Six cases required more than one surgery. One patient had an amputation. Among 13 cases of NF, 9 were confirmed by biopsy. Three of these had no sign of necrosis during surgery. Complications, reported in 25% of cases (7/28), included bone avascular necrosis, deforming scar, limb amputation, stroke, intracerebral abscess, hemiparesis, optic atrophy, palpebral ptosis and arthrosis. One patient (3.1%) with NF and varicella died on the day of admission. Two peaks (1998 and 2003) of severe soft tissue GAS infection were observed during the study period. NF is difficult to diagnose because of unspecific clinical features and unhelpful laboratory tests, such as CK. High index of suspicion is needed, particularly when varicella or STSS are present. To prove the diagnosis, a biopsy can be helpful when there is no necrosis seen during surgery. Further epidemiological studies are warranted to explain peaks of disease. Activity of varicella virus or GAS in the community could be related. Varicella vaccine could decrease the incidence of the disease.
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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 | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
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".