1 - Paediatric Department, Hospital Dona Estefânia, ULS São José, Lisbon, Portugal;
2 - Paediatric Infectious Diseases Unit, Hospital Santa Maria, ULS Santa Maria, Lisbon, Portugal;
3 - Paediatric Emergency Service and Infectious Diseases Unit, Hospital Pediátrico, ULS Coimbra, Portugal;
4 – Paediatrics Department, Hospital Eduardo Santos Silva, ULS Gaia Espinho, Porto, Portugal
5 – Paediatrics Department, Hospital Pedro Hispano, ULS Matosinhos, Porto, Portugal;
6 - Paediatric Intensive Care Unit, Hospital Santa Maria, ULS Santa Maria, Lisbon, Portugal;
7 - Paediatric Infectious Diseases Unit, Hospital São João, ULS São João, Porto, Portugal;
8 - Instituto de Microbiologia, Instituto de Medicina Molecular João Lobo Antunes, Faculdade de Medicina, Lisbon, Portugal;
9 - Comprehensive Health Research Centre (CHRC), Nova Medical School, Faculdade Ciências Médicas, Lisbon, Portugal
10 - Paediatric Intensive Care Unit, Hospital Dona Estefânia, ULS São José, Lisbon, Portugal;
11 - Laboratório de Microbiologia, Serviço de Patologia Clínica da ULS São José, Lisbon, Portugal;
12 - Paediatric Respiratory Unit, Hospital Pediátrico, ULS Coimbra
13 - Clinical Pathology Service, ULS Coimbra
12 - Laboratório de Biologia Molecular, Serviço de Patologia Clínica da ULS São João, Porto, Portugal
14 - Laboratório de Microbiologia, Serviço de Patologia Clínica da ULS São João, Porto, Portugal;
- E-poster com apresentação e discussão; Reunião internacional: The European Society for Paediatric Infectious Diseases ; Publicação sob forma de resumo;
Resumo:
Introdução Recently, invasive group A streptococcal (GAS) disease has emerged as an important cause of pneumonia. We aim to compare parapneumonic effusion/pleural empyema (PPE/PE) caused by GAS and Streptococcus pneumoniae (Sp).
Métodos A retrospective observational study of children with PPE/PE with identification of Sp or GAS in sterile biological samples, admitted to four Portuguese level III hospitals spread in the country, from 2018 to 2023. Two groups were defined: PPE/PE caused by Sp or GAS.
Resultados A total of 128 children with PPE/PE were included: 107 with Sp and 21 with GAS. A rise in PPE/PE was noted during 2023, mostly for GAS (1st trimester), with a mean age of 3.8 years (SD 2.9), 52.3% male. Most (89.8%) were identified by PCR in pleural fluid and 16.4% from culture. Children with GAS PPE/PE had more often rash (57.1% vs. 3.8%, p<0.001) and pharyngitis (52.4% vs. 19.8%, p=0.004). Also, septic shock (28.6% vs. 0.9%, p<0.001), admission to Intensive Care Unit (81.0% vs. 55.1%, p=0.030) and invasive mechanical ventilation (38.1% vs. 11.2%, p=0.005) were more common in the GAS PPE/PE group. Sequelae at 1-6 months were similar, but the mortality rate (9.5% vs 0%, p=0.026) was higher in the GAS PPE/PE. Among the cases where genotyping was possible, 4/7 GAS were emm1 (3/4 M1UK sublineage, all in 2023) and 64/88 were serotype 3 Sp, mostly in children with pneumococcal conjugate vaccine.
Conclusão The rise of GAS PPE/PE in 2023, was concomitant with the upsurge of M1UK in Portugal. GAS PPE/PE should be considered in children with rash and pharyngitis and these cases seem to have a more severe clinical course and a higher mortality rate when compared to Sp PPE/PE.
Palavras Chave: Derrame parapneumónico; Empiema; Streptococcus pyogenes; Streptococcus pneumoniae; Pneumonia;