Invasieve groep A-streptokokkeninfectie met evolutie naar sepsis: een casus

Abstract

Invasive group A streptococcal infection with evolution to sepsis: a case report An increasing incidence of invasive group A streptococci infections (iGAS) has recently been reported worldwide, with a marked increase in Flanders (Belgium) since autumn 2022. Although a turning point in this increase can be seen in March 2023, there are still significantly more infections in absolute numbers than in 2022. iGAS can have an aggressive disease progression and are associated with a significant morbidity and mortality. This case involves a 16-month-old girl with the clinical presentation of acute monoarthritis of the left knee, diagnosed as Streptococcus pyogenes septic arthritis. Consecutively, she developed osteomyelitis with evolution to a severe streptococcal toxic shock syndrome (STSS). The therapy consisted of antibiotics, especially cefotaxim and clindamycin, as well as surgical drainage and supportive care. A child with septic arthritis may present first to the general practitioner, but also to other disciplines, which makes general vigilance for iGAS necessary. The diagnosis of (peri)articular infections can be challenging. If septic arthritis is suspected, an X-ray and ultrasound of the involved joint should be performed. An MRI is the golden standard if osteomyelitis is suspected. Early detection of the disease allows a quicker initiation of the treatment (like antibiotics) and minimizes the risk of short- and long-term complications and mortality.