1/35. Fatal group A Streptococcal toxic shock-like syndrome in a child with varicella: report of the first well documented case with detection of the genetic sequences that code for exotoxins spe A and B, in Sao Paulo, brazil.A previously healthy seven-year-old boy was admitted to the intensive care unit because of toxaemia associated with varicella. He rapidly developed shock and multisystem organ failure associated with the appearance of a deep-seated soft tissue infection and, despite aggressive treatment, died on hospital day 4. An M-non-typable, spe A and spe B positive Group A Streptococcus was cultured from a deep soft tissue aspirate. The criteria for defining Streptococcal toxic shock-like syndrome were fulfilled. The authors discuss the clinical and pathophysiological aspects of this disease as well as some unusual clinical findings related to this case.- - - - - - - - - - ranking = 1keywords = varicella (Clic here for more details about this article) |
2/35. Varicella complicated by group A streptococcal sepsis and osteonecrosis.A 5-year-old boy presented with primary varicella zoster virus infection, group A streptococcal sepsis, toxic shock, and multisite osteonecrosis. An association between osteonecrosis and group A streptococcal sepsis has not been previously reported. Clinical recognition with supportive radiologic and pathologic findings are presented. Therapeutic guidelines are suggested.- - - - - - - - - - ranking = 0.2keywords = varicella (Clic here for more details about this article) |
3/35. Mycotic pseudoaneurysm of the aorta in children.Mycotic pseudoaneurysm of the aorta is a rare disease in childhood. We report on two cases which were diagnosed in an unselected general pediatric population within an 8-month period. The first case was a 16-month-old toddler with a normal cardiac history who presented with purulent pericarditis due to group A streptococcus and subsequent pseudoaneurysm formation of the ascending aorta while convalescing from varicella infection. The second case was a 14-year-old girl with a previously undiagnosed coarctation of the aorta who developed a staphylococcus aureus aortitis in the dilated poststenotic segment with pseudoaneurysm formation and infiltration into the adjacent lung tissue. In both cases parenteral antibiotic therapy was administered over 10 and 4 days, respectively, followed by emergency surgery consisting of aneurysmectomy, coarctectomy (case 2), and in situ homograft implantation. Recovery was uneventful. In both cases early institution of a femorofemoral cardiopulmonary bypass prevented a fatal outcome despite intraoperative rupture of the pseudoaneurysm.- - - - - - - - - - ranking = 0.2keywords = varicella (Clic here for more details about this article) |
4/35. endocarditis attributable to group A beta-hemolytic streptococcus after uncomplicated varicella in a vaccinated child.Varicella is generally a benign, self-limited childhood illness; however, severe, life-threatening complications do occur. A live, attenuated vaccine exists to prevent this illness, but controversy remains concerning the need to vaccinate children for what is generally a benign, self-limited disease, although more states are currently recommending this vaccine. We report a previously healthy 3-year-old who developed varicella 6 months after vaccination with no apparent skin superinfections, who subsequently developed group A beta-hemolytic streptococcus (GABHS) bacteremia resulting in endocarditis of a normal heart valve. We are unaware of previous reports of endocarditis related to GABHS after varicella. After developing a harsh, diastolic murmur that led to an echocardiogram, aortic valve endocarditis was diagnosed. A 6-week course of intravenous penicillin g was administered. Two weeks after the initiation of therapy, the diastolic murmur was harsher, and echocardiography revealed a large vegetation on the posterior leaflet of the aortic valve, with severe aortic insufficiency and a dilated left ventricle. The patient subsequently developed congestive heart failure requiring readmission and aggressive management. One month after the initial echocardiogram, a repeat examination revealed worsening aortic regurgitation and mitral regurgitation. The patient received an additional 4 weeks of intravenous penicillin and gentamicin followed by aortic valve replacement using the Ross procedure. Our patient, the first reported case of bacteremia and endocarditis from GABHS after varicella, illustrates the need for the health care practitioner to consider both common and life-threatening complications in patients with varicella. While cellulitis, encephalitis, and septic arthritis may be readily apparent on physical examination and commonly recognized complications of varicella, the possibility of bacteremia without an obvious skin superinfection should also be entertained. The case we report is unique in that the patient had normal immune function, had been previously vaccinated, and developed a rare complication of varicella-endocarditis-in a structurally normal heart with a previously unreported pathogen. Although a child may have been vaccinated against varicella, the chance of contracting the virus still exists and parents should be informed of this risk. group A beta-hemolytic streptococcus, endocarditis, varicella, Varivax, complications of varicella.- - - - - - - - - - ranking = 2.6keywords = varicella (Clic here for more details about this article) |
5/35. Childhood glomerulonephritis associated with varicella and streptococcal infection.Varicella is a usually benign disease of childhood and its complications are uncommon in immunocompetent children. In recent years we have witnessed the increasing virulence of group A beta-haemolytic streptococci (GABHS). In particular, in 1993, 50% of new cases of invasive GABHS disease were associated with varicella infection and all were suppurative complications. Because also a non suppurative complication of varicella as glomerulonephritis associated with GABHS infection, has been published in only one case, we feel that it could be of interest to describe this condition in two other cases we have observed.- - - - - - - - - - ranking = 1.2keywords = varicella (Clic here for more details about this article) |
6/35. Varicella complicated by group A streptococcal facial cellulitis.An increase has been recently noted in the incidence of life-threatening group A beta-hemolytic streptococcal (GABHS) infections in children recovering from varicella. We report our experience with a patient who required pediatric intensive care unit admission because of a serious GABHS infection 1 week after the onset of varicella. Emergency physicians must look for this complication in patients with varicella remaining abnormally febrile and presenting unusual manifestations.- - - - - - - - - - ranking = 0.6keywords = varicella (Clic here for more details about this article) |
7/35. Group A streptococcal osteomyelitis: severe presentation and course.AIM: To evaluate the course of group A streptococcal osteomyelitis associated with severe disease nowadays. methods: Three consecutive cases of severe group A streptococcal disease with osteomyelitis in children that were documented in beer Sheva, israel are described in detail. RESULTS: Two of the three cases were postvaricella. Early in the course of the disease, the presentation resembled that of severe cellulitis. All three patients had severe osteomyelitis and required surgery, and one patient developed chronic osteomyelitis. sepsis was diagnosed in two cases. CONCLUSION: Our cases are distinguishable from typical haematogenous staphylococcal osteomyelitis by the severe course and the extensive involvement of bone and soft tissues. The increase in severity of invasive group A streptococcal infections documented throughout the world could account for the difference between our complex cases and the previous reports.- - - - - - - - - - ranking = 0.2keywords = varicella (Clic here for more details about this article) |
8/35. Varicella complicated by scarlet fever.We report a 3-year-old boy with varicella complicated by cellulitis and scarlet fever. He developed a typical rash of scarlet fever following the onset of varicella. streptococcus pyogenes was isolated from the ulcers due to varicella. The present case suggests that scarlet fever may rarely develop following varicella and should be considered in children with complicated varicella.- - - - - - - - - - ranking = 1keywords = varicella (Clic here for more details about this article) |
9/35. abscess formation as a complication of chickenpox.chickenpox is a common infectious disease of childhood. skin lesions may occasionally become secondarily infected with bacteria. Large abscess formation is reported complicating a mild case of chickenpox in a previously healthy patient.- - - - - - - - - - ranking = 1.3898933189122keywords = chickenpox (Clic here for more details about this article) |
10/35. Group A streptococcus bacteraemia complicated by osteomyelitis in an immunocompetent adult.osteomyelitis due to group A streptococcus is an unusual complication of varicellae in children. We report the first case of group A streptococcus bacteraemia complicated by multifocal osteomyelitis in an adult.- - - - - - - - - - ranking = 0.2keywords = varicella (Clic here for more details about this article) |
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