1 - Unidade de Infeciologia, Área de Pediatria, Hospital de Dona Estefânia, ULSS.José, Lisboa, Portugal
2 - Unidade de Infeciologia, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
3 - Laboratório Nacional de Referência a Infeções Respiratórias a Agentes Bacterianos, Departamento de Doenças Infeciosas, Instituto Nacional de Saúde Dr. Ricardo Jorge, Lisboa, Portugal
4 - Instituto de Microbiologia, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
- Reunião internacional, ESPID 2024
Resumo:
Background: Upsurges of invasive Group A Streptococcus disease (iGAS) have been reported since September 2022 in Europe.
Materials/methods: A nationwide prospective surveillance of pediatric (<18 yrs) iGAS in Portugal was conducted between January 1, 2014, and August 31, 2023.
Results: We identified 314 cases. Clinical data was recorded (n=282) and the genomic sequence of available isolates (n=170) was determined. There was a significant upsurge of cases in the 2022/23 season, 4-fold higher than in pre-pandemic seasons. The rate of preceding respiratory infection (21.2%) and varicella (21.9%) was similar in all seasons. Comparing 2022/23 (n=113) with previous seasons (n=169) the dominant clinical presentation was sepsis (28.3% vs 14.7%, p=0.002), followed by pneumonia, similar in both periods (25.7% vs 23%, p=0.6). No significant differences in ICU admissions were noted, but patients had more tachycardia (75.3% vs 51.3%, p=0.002), renal insufficiency (10.3% vs 3.2%, p=0.03) and needed drainage more often (46% vs 26%, p<0.001). Intravenous immunoglobulin (10.6% vs 5.2%, p=0.001) and concomitant clindamycin (67.6% vs 46.7%, p=0.001) were more commonly administered. The case-fatality rate was similar in both periods (5%), although sequelae at 30 days of discharge were higher (18.7% vs 7.1%, p=0.003). There was a clear dominance of emm1 (57% vs 35.6%, p= 0.019), mostly the M1UK sub-lineage (82.5% vs 39.4%, p<0.001). Overall, there were no significant associations between individual emm types or clusters and STSS or mortality, although emm1 (but not M1UK alone) was associated with ICU admission.
Conclusions: The sharp increase of pediatric iGAS in Portugal in late 2022, was not related to a dominant respiratory co-infection, but was associated to an expansion of the M1UK sub-lineage. A significant morbidity was recorded but there was no significant increase in mortality.
Palavras Chave: Streptococcus do Grupo A, Pediatria, doença invasiva