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Invasive group A Streptococcus infections before and after the COVID-19 pandemic
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Introdução: Em 2022 vários países europeus registaram um número crescente de casos de doença invasiva causada pelo Streptococcus do Grupo A (iGAS) em doentes pediátricos, bem como do número de mortes associadas, em comparação com os anos anteriores. Durante a pandemia COVID-19 os padrões normais de interação social foram interrompidos, o que pode ter levado a alterações na forma como doenças como iGAS se apresentam. Objetivo: Realizar uma análise comparativa dos casos de infeção por iGAS antes e depois da pandemia COVID-19, para melhor compreender como esta afetou a incidência e gravidade desta doença. Métodos: Estudo retrospectivo realizado através da revisão dos dados clínicos e demográficos dos doentes internados na unidade de cuidados intensivos pediátricos da Unidade Local de Saúde Santa Maria (ULSSM) com o diagnóstico de infeção por iGAS, de junho de 2007 a fevereiro de 2020 e de março de 2020 a fevereiro de 2024 (períodos pré e pós-COVID-19, respetivamente). Resultados: Foram internados 54 doentes, 38 no período pré e 16 no período pós- COVID-19. A frequência média por ano aumentou no período pós-COVID-19 (2,7 vs 5,3 casos/ano) e foi máxima em 2023 (11). A mediana de idades foi 4 anos (3 vs 5), 7 eram lactentes, 30 eram rapazes e 19 tinham comorbilidades. Trinta e sete obtiveram um diagnóstico definitivo. As apresentações clínicas mais frequentes foram pneumonia (55% vs 56%) e SCT (40% vs 44%). No período pós-COVID-19 um maior número de doentes desenvolveu insuficiência respiratória (34% vs 44%), empiema pleural (29% vs 56%) e disfunção multiorgânica (8% vs 13%). O número de doentes que necessitou de suporte cardiovascular e ventilação mecânica foi também superior (40% vs 44% e 40% vs 56%, respetivamente). Todos os doentes foram tratados com antibióticos betalactâmicos, 42 com clindamicina adjuvante e 11 com imunoglobulina intravenosa. Para controlo de foco, foram colocados 25 drenos torácicos e realizadas 13 cirurgias. Tanto a probabilidade de morte estimada pelo PRISM Score como a mortalidade efetiva foram superiores no período pós-pandemia (5% vs 11% e 8% vs 19%, respetivamente). A principal causa de morte foi disfunção multiorgânica associada ao SCT. Cinco doentes sobreviveram com sequelas, a maioria neurológicas.
Introduction: In 2022 several European countries reported an increasing number of Invasive Group A Streptococcus (iGAS) cases in children, as well as related deaths, when compared with previous years. During the COVID-19 pandemic normal social mixing patterns were interrupted which may have led to changes in how diseases such as iGAS infection present. Objective: Carry out a comparative analysis of iGAS infection cases before and after the COVID-19 pandemic, to better understand how it has affected the incidence and severity of this disease. Methods: Retrospective study of patients admitted to the paediatric intensive care unit (PICU) of Unidade Local de Saúde Santa Maria (ULSSM) with an iGAS infection diagnosis, from June 2007 till February 2020 and from March 2020 till February 2024 (pre and post-COVID-19 periods, respectively). Demographic and clinical data were analysed. Results: There were 54 patients admitted with iGAS diagnosis: 38 pre and 16 in the post-COVID-19 periods. The average frequency per year increased in the post-COVID- 19 period (2,7 vs 5,3 cases/year) and was maximum in 2023 (11). The median age was 4 years (3 vs 5), 7 patients were infants, 30 were boys and 19 had comorbidities. Thirty-seven obtained a definitive diagnosis. The most frequent clinical presentations were pneumonia (55% vs 56%) and Streptococcal Toxic Shock Syndrome (STSS) (40% vs 44%). In the post-COVID-19 period a higher number of patients developed respiratory failure (34% vs 44%), pleural empyema (29% vs 56%) and multiple organ dysfunction (8% vs 13%). Cardiovascular and mechanical ventilation supports were also superior (40% vs 44% and 40% vs 56%, respectively). All patients received beta-lactam antibiotics, 42 received adjuvant clindamycin and 11 intravenous immunoglobulin. For source control, 25 chest drains were inserted and 13 surgeries were performed. Both effective and predicted mortality by PRISM score were higher in the post-pandemic period (8% vs 19% and 5% vs 11%, respectively). The leading cause of death was multiorgan dysfunction in patients with STSS. Five patients survived with sequelae, mostly neurological. Conclusion: In our study we observed a twofold increase in the number of iGAS infections after the COVID-19 pandemic. Severity of disease was also higher as demonstrated by the rate of complications, organ failure and mortality observed. Further studies are needed to better understand the pathophysiology and clinical course, seeking for potential alternative ways to prevent and treat iGAS infections.
Introduction: In 2022 several European countries reported an increasing number of Invasive Group A Streptococcus (iGAS) cases in children, as well as related deaths, when compared with previous years. During the COVID-19 pandemic normal social mixing patterns were interrupted which may have led to changes in how diseases such as iGAS infection present. Objective: Carry out a comparative analysis of iGAS infection cases before and after the COVID-19 pandemic, to better understand how it has affected the incidence and severity of this disease. Methods: Retrospective study of patients admitted to the paediatric intensive care unit (PICU) of Unidade Local de Saúde Santa Maria (ULSSM) with an iGAS infection diagnosis, from June 2007 till February 2020 and from March 2020 till February 2024 (pre and post-COVID-19 periods, respectively). Demographic and clinical data were analysed. Results: There were 54 patients admitted with iGAS diagnosis: 38 pre and 16 in the post-COVID-19 periods. The average frequency per year increased in the post-COVID- 19 period (2,7 vs 5,3 cases/year) and was maximum in 2023 (11). The median age was 4 years (3 vs 5), 7 patients were infants, 30 were boys and 19 had comorbidities. Thirty-seven obtained a definitive diagnosis. The most frequent clinical presentations were pneumonia (55% vs 56%) and Streptococcal Toxic Shock Syndrome (STSS) (40% vs 44%). In the post-COVID-19 period a higher number of patients developed respiratory failure (34% vs 44%), pleural empyema (29% vs 56%) and multiple organ dysfunction (8% vs 13%). Cardiovascular and mechanical ventilation supports were also superior (40% vs 44% and 40% vs 56%, respectively). All patients received beta-lactam antibiotics, 42 received adjuvant clindamycin and 11 intravenous immunoglobulin. For source control, 25 chest drains were inserted and 13 surgeries were performed. Both effective and predicted mortality by PRISM score were higher in the post-pandemic period (8% vs 19% and 5% vs 11%, respectively). The leading cause of death was multiorgan dysfunction in patients with STSS. Five patients survived with sequelae, mostly neurological. Conclusion: In our study we observed a twofold increase in the number of iGAS infections after the COVID-19 pandemic. Severity of disease was also higher as demonstrated by the rate of complications, organ failure and mortality observed. Further studies are needed to better understand the pathophysiology and clinical course, seeking for potential alternative ways to prevent and treat iGAS infections.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2024
Palavras-chave
Streptococcus do grupo A Invasiva COVID-19 Pediatria