{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,28]],"date-time":"2026-06-28T17:02:15Z","timestamp":1782666135155,"version":"3.54.5"},"reference-count":31,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2014,6,9]],"date-time":"2014-06-09T00:00:00Z","timestamp":1402272000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Paediatrics Child Health"],"published-print":{"date-parts":[[2014,9]]},"abstract":"<jats:sec><jats:title>Aim<\/jats:title><jats:p>To describe the clinical presentation, management and outcomes for children with invasive group <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content> streptococcal (<jats:styled-content style=\"fixed-case\">GAS<\/jats:styled-content>) infection in a paediatric intensive care unit (<jats:styled-content style=\"fixed-case\">PICU<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We reviewed the clinical and laboratory records of patients admitted to a <jats:styled-content style=\"fixed-case\">PICU<\/jats:styled-content> in <jats:styled-content style=\"fixed-case\">M<\/jats:styled-content>elbourne with invasive <jats:styled-content style=\"fixed-case\">GAS<\/jats:styled-content> infection from <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>pril 2010 to <jats:styled-content style=\"fixed-case\">A<\/jats:styled-content>pril 2013. Outcomes recorded included survival, organ failure, need for extracorporeal support, renal replacement therapy and prolonged neuromuscular weakness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Twelve cases of invasive <jats:styled-content style=\"fixed-case\">GAS<\/jats:styled-content> infection were identified. The most common clinical presentations were pneumonia (<jats:italic>n<\/jats:italic>\u2009=\u20095), bacteraemia with no septic focus (<jats:italic>n<\/jats:italic>\u2009=\u20094) and septic arthritis (<jats:italic>n<\/jats:italic>\u2009=\u20093). Necrotising fasciitis occurred in one patient and another patient presented with ischaemic lower limbs requiring amputation. Of the eight isolates with available <jats:italic>emm<\/jats:italic> typing results, the most common <jats:italic>emm<\/jats:italic> type was <jats:italic>emm<\/jats:italic>1 (<jats:italic>n<\/jats:italic>\u2009=\u20094) followed by <jats:italic>emm<\/jats:italic>4, 12 and 22. Nine patients had multi\u2010organ failure. Ten patients required mechanical ventilation for a median duration of 8 days. Nine patients required inotropic and\/or vasopressor support and four patients extracorporeal membrane oxygenation support. Eleven patients survived. A prolonged period of neuromuscular weakness following the initial severe illness was common (<jats:italic>n<\/jats:italic>\u2009=\u20095), but most children returned to normal or near normal neurological function.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Invasive <jats:styled-content style=\"fixed-case\">GAS<\/jats:styled-content> disease in children may cause severe multi\u2010organ failure with resultant prolonged intensive care stay and significant morbidity. However, a high rate of survival and return to normal functioning may be achieved with multi\u2010system intensive care support and multi\u2010disciplinary rehabilitation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jpc.12601","type":"journal-article","created":{"date-parts":[[2014,6,9]],"date-time":"2014-06-09T06:22:54Z","timestamp":1402294974000},"page":"687-692","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":20,"title":["Severe group <scp>A<\/scp> streptococcal infections in a paediatric intensive care unit"],"prefix":"10.1111","volume":"50","author":[{"given":"Anna","family":"Lithgow","sequence":"first","affiliation":[{"name":"Paediatric Intensive Care Unit The Royal Children's Hospital  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trevor","family":"Duke","sequence":"additional","affiliation":[{"name":"Paediatric Intensive Care Unit The Royal Children's Hospital  Melbourne Victoria Australia"},{"name":"Centre for International Child Health The University of Melbourne  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Steer","sequence":"additional","affiliation":[{"name":"Department of General Medicine The Royal Children's Hospital  Melbourne Victoria Australia"},{"name":"Centre for International Child Health The University of Melbourne  Melbourne Victoria Australia"},{"name":"Group A Streptococcal Research Group The Murdoch Children's Research Institute  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierre Robert","family":"Smeesters","sequence":"additional","affiliation":[{"name":"Group A Streptococcal Research Group The Murdoch Children's Research Institute  Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,6,9]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1993.03500030082037"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/21.5.1220"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis422"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00422-08"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1086\/521264"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.5694\/j.1326-5377.2007.tb01054.x"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1086\/648963"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1601-0825.2002.1o816.x"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.2165\/11634180-000000000-00000"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1086\/341409"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.2165\/00148581-200507010-00002"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006454-199401000-00011"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199608223350803"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1442-200X.2007.02378.x"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/0009922807299940"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1651-2227.2005.tb01979.x"},{"key":"e_1_2_7_18_1","unstructured":"KotloffK Van BenedenC.Standardization of Epidemiologic Protocols for Surveillance of Acute Disease Caused byStreptococcus pyogenes: Pharyngitis Impetigo and Invasive Disease 2008. 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