Tiivistelmä

Vaikeat A-ryhmän streptokokki-infektiot lisääntyvät kaikkialla maailmassa.

Vesirokko on lapsilla tärkein yksittäinen altistava tekijä. Myös pienet ihorikkoumat, leikkaus, tylppä vamma tai A-streptokokin aiheuttama tauti perheenjäsenellä lisäävät riskiä.

Infektiofokus voi olla missä kohdassa elimistöä tahansa. Pehmytosan vaikea kipu voi olla diagnostinen vihje invasiivisesta streptokokki-infektiosta.

Nopea hoidon aloitus beetalaktaamin ja klindamysiinin yhdistelmällä ja tarvittaessa kirurginen fokuksen avaus nopeuttavat paranemista ja vähentävät kuolleisuutta.

Abstract

The incidence of invasive group A streptococcal (GAS) infections is increasing globally. The changes in the epidemiology and increased severity of the infections have been discovered to be due to several mutations in the strains of GAS. These mutations lead to high production of various superantigens in the bacteria and further to more severe forms of infection as these superantigens act as enzymes and proteases destroying infected tissues.

The majority of childhood invasive GAS infections occur in previously healthy children. Chickenpox, surgery, minor skin trauma and GAS infection in the family increase the risk of serious infections. Necrotizing fasciitis and streptococcal toxic shock syndrome are the most serious clinical pictures of GAS infections with mortality rates of 2–28%. Fasciitis is most commonly located in the lower extremities and severe focal pain may be an important red flag sign in a child with high fever.

Treatment with empiric antibiotics should be started based on suspicion of an invasive GAS infection already, usually with a combination of a beta lactam and clindamycin. When GAS has been proven as a cause of infection, a combination of high dose penicillin and clindamycin are the drugs of choice. Surgical revision of the focus speeds recovery and improves survival.