Invasive Group A Streptococcal Infection Concurrent with 2009 H1N1 Influenza

[tetano]

Clin Infect Dis. 2010 Apr 8. [Epub ahead of print]
Invasive Group A Streptococcal Infection Concurrent with 2009 H1N1 Influenza.

Jean C, Louie JK, Glaser CA, Harriman K, Hacker JK, Aranki F, Bancroft E, Farley S, Ginsberg M, Hernandez LB, Sallenave CS, Radner AB.

California Department of Public Health, Richmond, 2Fresno County Department of Public Health, Fresno, 3Los Angeles Department of Public Health, Los Angeles, 4Contra Costa Health Services, Martinez, 5San Diego County Health and Human Services, San Diego, 6Monterey County Health Department and 7Salinas Valley Memorial Hospital, Salinas, and 8San Mateo County Health System, San Mateo, California.
Abstract

We describe 10 patients with 2009 H1N1 influenza and concurrent invasive group A streptococcal infection with marked associated morbidity and mortality. Seven patients required intensive care, 8 required mechanical ventilation, and 7 died. Five of the patients, including 4 of the fatalities, were previously healthy

PMID: 20377405 [PubMed - as supplied by publisher]

http://www.ncbi.nlm.nih.gov/pubmed/20377405?dopt=Abstract

 

[kent nickell]

Re: Invasive Group A Streptococcal Infection Concurrent with 2009 H1N1 Influenza

excerpts ....

Confirmed and probable cases of 2009 H1N1 influenza were reported to the California Department of Public Health (CDPH) by local health departments.

During 3 April?26 December 2009, there were 8075 hospitalized patients and/or fatalities with 2009 H1N1 influenza reported in California, including 1656 ICU patients and 461 fatalities. Of these 8075 persons, 10 patients with concurrent invasive GAS (Group A Strep) infection were identified.

The median age of the 10 patients with 2009 H1N1 influenza and invasive GAS infection was 37 years (range, 5?66 years); 3 were less than
18 years old.

Although our numbers are also small, it is remarkable that 70% of the patients described in this series died, compared with an overall 6% mortality rate for hospitalized 2009 H1N1 influenza patients in California.

Of the 9 patients in our series who required intensive care or died, 5 were previously healthy, reminding us that concurrent GAS infection and 2009 H1N1 influenza can lead to severe disease or death among persons who typically are not considered to be at risk for severe illness from either of these pathogens.

2009 H1N1 influenza vaccine was not available at the time of infection in these cases

 

[sharon sanders]

Re: Invasive Group A Streptococcal Infection Concurrent with 2009 H1N1 Influenza

Thank you Tetano and Kent.

Last Summer some of the teenagers and college students who died from A/H1N1 had undiagnosed strep infections at the time of hospital admission.

Would an infusion of antibiotics help in this situation?

 

[kent nickell]

Re: Invasive Group A Streptococcal Infection Concurrent with 2009 H1N1 Influenza

From the paper... (The paper talks about how different institutions seem to be reporting different scenarios. Some where severe viral pneumonia without bacterial coinfection seems to predominate and some are seeing the more common coinfections of Strep pnemo and Staph aureus. This paper reports on Group A strep. For a very ill influenza like illness it seems antiviral therapy should be started and ideally an antibiotic reflective of the exact bacterial coinfection. Often bacterial cultures are not able to be obtained in time and treatment has to be empirical based on the clinical condition and knowledge of the local pattern of bacterial infections)



"""In conclusion, our findings suggest that GAS infection concurrent with 2009 H1N1 influenza is often severe. Clinicians should remain vigilant for the possibility of severe illness caused by bacterial coinfection, including GAS infection. The performance of routine cultures of blood samples obtained early in the hospital course and before administration of antibiotics cannot be overemphasized. Although judicious use of antimicrobials is recommended, physicians should strongly consider early coverage for both 2009 H1N1 influenza and bacterial coinfection in critically ill patients suspected to have influenza."""