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ARTICLE |

Outbreak of Group A Streptococcus Septicemia in Children:  Clinical, Epidemiologic, and Microbiological Correlates

Mary C. Wheeler, MA; Martha H. Roe; Edward L. Kaplan, MD; Patrick M. Schlievert, PhD; James K. Todd, MD
JAMA. 1991;266(4):533-537. doi:10.1001/jama.1991.03470040097029.
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Objective.  —To determine the epidemiologic, clinical, and microbiological features of group A streptococcus septicemia in children.

Design.  —A descriptive series of 34 cases over an 11-year period from 1980 through 1990.

Setting.  —An academically affiliated tertiary-care pediatric hospital, the principal referral center for the state of Colorado and surrounding states.

Participants.  —Thirty-four patients with positive blood cultures for group A streptococcus (33 medical records were available).

Main Outcome Measures.  —Yearly incidence and clinical features of cases; microbiological features of isolated organisms.

Results.  —There was a significant increase (P =.01) in the incidence of group A streptococcus bacteremia over an 11-year period, with 14 (41%) of these cases occurring in 1989 and 1990. Patients had a rapidly progressing illness, usually without preceding pharyngitis. The prominent M and T types were 1 (4) and 12 (4). Eleven (73%) of the 15 strains produced pyrogenic exotoxin B that significantly correlated with production of proteinase.

Conclusion.  —There appears to be an increase in group A streptococcus bacteremia in children that is associated with a strain phenotype that suggests a change in organism virulence.(JAMA. 1991;266:533-537)

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