{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,11]],"date-time":"2025-12-11T20:50:07Z","timestamp":1765486207554,"version":"3.44.0"},"reference-count":9,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2018,7,2]]},"abstract":"<jats:p>We report a previously well paediatric patient with two distinct presentations of invasive group A streptococcus (GAS) infection resulting in significant morbidity. The first episode, following GAS pharyngitis, involved multiorgan dysfunction syndrome. This included cardiorespiratory and acute hepatorenal failure and purpura fulminans that eventually necessitated four-limb amputation. The second episode occurred 12 months later, from undetermined aetiology, and resulted in septic shock. Molecular analysis of the emm gene and PCR for Serum Opacity Factor revealed that the initial isolate was M Type 4 and sof gene positive while the second isolate was M Type 1 and sof gene negative. Immunological investigations, including CH50, quantitative IgA, IgM and IgG, and flow cytometry measuring lymphocyte subsets, and vaccine response to measles, mumps, rubella and pneumococcus were normal. This is the first report of recurrent bacteraemia from different strains of <jats:italic>Streptococcus pyogenes<\/jats:italic> infection in an apparently immunocompetent child.<\/jats:p>","DOI":"10.1136\/bcr-2018-225292","type":"journal-article","created":{"date-parts":[[2018,7,30]],"date-time":"2018-07-30T09:17:31Z","timestamp":1532942251000},"page":"bcr-2018-225292","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Recurrent invasive group A streptococcal infection with four-limb amputation in an immunocompetent child"],"prefix":"10.1136","volume":"2018","author":[{"given":"Nour","family":"Gazzaz","sequence":"first","affiliation":[{"name":"Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada"},{"name":"King Abdulaziz University, Jeddah, Saudi Arabia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy","family":"Mailman","sequence":"additional","affiliation":[{"name":"Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8919-9383","authenticated-orcid":false,"given":"Jennifer Ruth","family":"Foster","sequence":"additional","affiliation":[{"name":"Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada"},{"name":"Critical Care, Dalhousie University, Halifax, Nova Scotia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,7,30]]},"reference":[{"key":"2025082707411218000_2018.jul27_1.bcr-2018-225292.1","doi-asserted-by":"crossref","first-page":"539","DOI":"10.2183\/pjab.91.539","article-title":"Molecular and genomic characterization of pathogenic traits of group A Streptococcus pyogenes","volume":"91","author":"Hamada","year":"2015","journal-title":"Proc Jpn Acad Ser B Phys Biol Sci"},{"key":"2025082707411218000_2018.jul27_1.bcr-2018-225292.2","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1016\/j.jiac.2015.12.014","article-title":"Recurrent bacteremia with different strains of Streptococcus pyogenes in an immunocompromised child","volume":"22","author":"Hattori","year":"2016","journal-title":"J Infect Chemother"},{"key":"2025082707411218000_2018.jul27_1.bcr-2018-225292.3","first-page":"e00020","article-title":"Cytosolic replication of group A streptococcus in human macrophages","volume":"7","author":"O\u2019Neill","year":"2016","journal-title":"MBio"},{"key":"2025082707411218000_2018.jul27_1.bcr-2018-225292.4","first-page":"390","article-title":"[Bacteremia and recurrent arthritis caused by Streptococcus pyogenes in a heroin addict with AIDS]","volume":"12","author":"Santos","year":"1994","journal-title":"Enferm Infecc Microbiol Clin"},{"key":"2025082707411218000_2018.jul27_1.bcr-2018-225292.5","doi-asserted-by":"publisher","DOI":"10.1080\/003655401317074518"},{"key":"2025082707411218000_2018.jul27_1.bcr-2018-225292.6","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.02378-10"},{"key":"2025082707411218000_2018.jul27_1.bcr-2018-225292.7","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cit558"},{"key":"2025082707411218000_2018.jul27_1.bcr-2018-225292.8","doi-asserted-by":"publisher","DOI":"10.1086\/650167"},{"key":"2025082707411218000_2018.jul27_1.bcr-2018-225292.9","doi-asserted-by":"publisher","DOI":"10.1084\/jem.158.5.1727"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2018-225292","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T14:41:18Z","timestamp":1756305678000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2018-225292"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,7,30]]},"references-count":9,"alternative-id":["10.1136\/bcr-2018-225292"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2018-225292","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2018,7,30]]}}}