A Case-Control Study of Necrotizing Fasciitis During Primary Varicella

Zerr, Danielle M.; Alexander, E. Russell; Duchin, Jeff; Koutsky, Laura A.; Rubens, Craig E.

doi:10.1542/peds.103.4.783

Cited by 170 publications

(84 citation statements)

References 36 publications

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“…Another potential risk associated with the use of ibuprofen is the possible association between ibuprofen and varicella-related invasive group A streptococcal infection. 68,69 However, at the time of this report, data were insufficient to support a causal relationship between ibuprofen and invasive group A streptococcal disease.…”

Section: Ibuprofenmentioning

confidence: 86%

Fever and Antipyretic Use in Children

Sullivan¹,

Farrar²

2011

Pediatrics

363

313

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Fever in a child is one of the most common clinical symptoms managed by pediatricians and other health care providers and a frequent cause of parental concern. Many parents administer antipyretics even when there is minimal or no fever, because they are concerned that the child must maintain a “normal” temperature. Fever, however, is not the primary illness but is a physiologic mechanism that has beneficial effects in fighting infection. There is no evidence that fever itself worsens the course of an illness or that it causes long-term neurologic complications. Thus, the primary goal of treating the febrile child should be to improve the child's overall comfort rather than focus on the normalization of body temperature. When counseling the parents or caregivers of a febrile child, the general well-being of the child, the importance of monitoring activity, observing for signs of serious illness, encouraging appropriate fluid intake, and the safe storage of antipyretics should be emphasized. Current evidence suggests that there is no substantial difference in the safety and effectiveness of acetaminophen and ibuprofen in the care of a generally healthy child with fever. There is evidence that combining these 2 products is more effective than the use of a single agent alone; however, there are concerns that combined treatment may be more complicated and contribute to the unsafe use of these drugs. Pediatricians should also promote patient safety by advocating for simplified formulations, dosing instructions, and dosing devices.

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Section: Ibuprofenmentioning

confidence: 86%

Fever and Antipyretic Use in Children

Sullivan¹,

Farrar²

2011

Pediatrics

363

313

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“…17,36,37 A recent case-control study suggested a link between ibuprofen use and NF in children with varicella. 36 However, most of the patients who used ibuprofen did so only after the onset of GAS symptoms and the use of this drug is likely to have been a response to infection in persons with severe disease rather than a cause.…”

Section: Discussionmentioning

confidence: 99%

Invasive Group A Streptococcal Disease in Children and Association With Varicella-Zoster Virus Infection

Davies²,

et al. 2000

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ABSTRACT. Objectives. To describe the incidence and clinical features of invasive group A streptococcal (GAS) disease in children in Ontario and determine the risk of invasive GAS infection following chickenpox.Methods. During 1992-1996, we conducted prospective, active, population-based surveillance for pediatric invasive GAS disease in Ontario, Canada (population: 11 million; 2.5 million children) and reviewed clinical and laboratory records.Results. There were 1.9 cases of invasive GAS disease per 100 000 children per year. Streptococcal toxic shock syndrome (STSS) occurred in 7% of cases and necrotizing fasciitis (NF) in 4% for incidences of .08 and .13 per 100 000 per year, respectively. Case-fatality rates were 56% for STSS, 10% for NF, and 4% overall. The presence of chronic underlying illness other than asthma was associated with death (relative risk [RR]: 11; 95% confidence interval [CI]: 2.4 -45). Fifteen percent of children identified had preceding chickenpox infection, which significantly increased the risk for acquisition of invasive GAS disease (RR: 58; 95% CI: 40 -85). Children with invasive GAS and recent chickenpox were more likely to have NF (RR: 6.3; 95% CI: 1.8 -22.3).Conclusions. Childhood invasive GAS disease occurs at an incidence similar to the adult population but has a lower rate of STSS and case-fatality. Chickenpox dramatically increases the risk for acquiring invasive GAS disease, and universal chickenpox vaccination could potentially prevent up to 15% of all pediatric invasive GAS disease. Pediatrics 2000;105(5). URL: http://www. pediatrics.org/cgi/content/full/105/5/e60; varicella, group A streptococcus, pediatric, risk. ABBREVIATIONS. GAS, group A streptococcus/streptococcal; NF, necrotizing fasciitis; STSS, streptococcal toxic shock syndrome; VZV, varicella-zoster virus; RR, relative risk; CI, confidence interval; IL, interleukin. T he past 15 years have witnessed a striking resurgence in the incidence and severity of infections caused by group A streptococci (GAS), including necrotizing fasciitis (NF) and the streptococcal toxic shock syndrome (STSS).1-9 Numerous hospital-based case series have been reported on the clinical spectrum of pediatric invasive GAS disease and have identified that varicella-zoster virus (VZV) infection commonly precedes these infections, especially in cases of NF.10 -21 However, to adequately define the epidemiology of these infections, population-based studies are required. Published reports from population-based surveillance of invasive GAS infection have included relatively few pediatric cases.3,5 This limits conclusions regarding the incidence and clinical features of this disease in children.Our group previously reported the results of prospective, population-based surveillance for invasive GAS disease in Ontario, Canada, in 1992-1993, identifying 323 cases of which only 81 were in children. 3 The objective of this study was to describe the incidence and clinical features of invasive GAS disease in children in a large population (Ontario) and to b...

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“…For instance, influenza viral infection is well known to predispose humans to severe morbidity and mortality from common respiratory bacterial pathogens (5)(6)(7). Varicella also predisposes for severe streptococcal and staphylococcal toxic shock-like syndrome (8,9). The mechanism for this coupling is not well understood.…”

mentioning

confidence: 99%

A Role for IFN-αβ in Virus Infection-Induced Sensitization to Endotoxin

Doughty

Nguyen

Durbin

et al. 2001

The Journal of Immunology

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Underlying viral infections can heighten sensitivity and worsen cytokine-mediated disease following secondary inflammatory challenges. Mechanisms for this are poorly understood. The impact of the innate response to lymphocytic choriomeningitis virus (LCMV) infection on sensitivity to endotoxin (LPS) was investigated. Compared with uninfected mice, infection with LCMV for 2-days-sensitized mice to LPS by ∼2-fold for lethality and by 2- to 6-fold for serum TNF-α levels. Priming for LPS-induced TNF-α was also seen with splenic and peritoneal leukocytes isolated from infected mice and challenged with LPS ex vivo. The effect on TNF-α production was present in the absence of IFN-γ, its major producers NK and T cells, and the major pathways for its induction through IL-12 and the signal transducer and activator of transcription 4 (STAT4), and therefore was IFN-γ independent. Early LCMV infection induces high concentrations of the type 1 IFNs, IFN-αβ. Administration of recombinant IFN-α alone heightened the TNF-α response to LPS. Innate IFN-αβ and IFN-γ responses to LCMV exist in a delicate balance. To reduce priming for LPS-induced TNF-α during LCMV, deficiencies in both the IFN-αβ and IFN-γ receptors or STAT1, a transcription factor downstream to both IFNs, were required. These data demonstrate that early viral infection can enhance sensitivity to bacterial products, and that this sensitization can occur in part as a result of endogenously expressed IFN-αβ. This work also raises issues about potential complications associated with IFN-αβ therapies.

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A Case-Control Study of Necrotizing Fasciitis During Primary Varicella

Abstract: Ibuprofen use was associated with NF in the setting of primary varicella. Additional studies are needed to establish whether ibuprofen use has a causal role in the development of NF and its complications during varicella.

Cited by 170 publications

References 36 publications

Fever and Antipyretic Use in Children

Fever and Antipyretic Use in Children

Invasive Group A Streptococcal Disease in Children and Association With Varicella-Zoster Virus Infection

A Role for IFN-αβ in Virus Infection-Induced Sensitization to Endotoxin

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