A Case Series of Noninvasive (non-iGAS) and Invasive (iGAS) Pediatric Group A Streptococcal Infections at a Tertiary Healthcare Center: Resurgence and Concomitant Viral Infections

Abstract Background After a decrease in pediatric invasive group A streptococcal cases during the peak of the COVID-19 infection isolation guidelines in 2020 and 2021, the Centers for Disease Control and Prevention (CDC) documented a surge in cases in multiple states across the United States during late 2022.Methods We performed a retrospective chart review exploring both invasive pediatric group A streptococcal infections (iGAS) and noninvasive group A streptococcal infections (non-iGAS) admissions to the Children’s Hospital of Georgia from July 1, 2021 to June 30, 2023. Demographics, seasonality, concomitant viral and bacterial infections, antibiotic use preferences, pediatric intensive care (PICU) admission, and mortality were included.Results We found a substantial increase in both iGAS and non-iGAS cases during the study time. Most patients with iGAS presented were teenagers, white, and had sepsis and bacteremia. Non iGAS patients were not older than 11 years of age, were predominantly back, and had complicated pneumonia. Influenza was the most common concomitant virus seen in invasive and noninvasive cases, but our sample also included infections with respiratory syncytial virus (RSV), metapneumovirus (HMPV), rhinovirus and adenovirus among others. Methicillin-sensitive staphylococcus (MSSA) aureus was the most common bacteria seen in patients with both invasive and noninvasive disease. Treatment optimization was only achieved after pediatric Infectious Diseases consultation.Conclusions The surge in noninvasive and invasive pediatric GAS disease seen at our institution matched the end of COVID-19 infection masking policies in the United States. This drastic rise should be recognized, and surveillance should be reinforced. Increased knowledge and understanding of this surge in group A streptococcal infections will allow for early intervention and treatment, thereby reducing morbidity and mortality.