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• W4381250632 abstract "<h3>Objectives</h3> A marked increase in attendances to the Children’s Emergency Department was noted in the winter of 2022 in this centre. Parent and physician concerns about Group A streptococcal infections resulted in an unprecedented number of children with tonsillitis and scarlet fever presenting to ED. This was in addition to the winter viral infections. The objectives of this study are to describe the spectrum of invasive Group A streptococcal infections(iGAS) seen in the centre. <h3>Methods</h3> Clinical presentations of those children who presented with (iGAS) infections to this centre with two Emergency Departments covering three boroughs were reviewed. <h3>Results</h3> There was a marked increase in the number of children who presented with scarlet fever and tonsillitis to our EDs. Four children presented with symptoms of lower respiratory tract infections and were diagnosed with pleural empyema. A 12 year old presented with a week of fever and cough followed by new onset limp and confusion. He was diagnosed to have a subdural empyema which was drained and grew GAS, he made a full recovery. A 3 year old presented with a progressively increasing neck swelling for 10 days. Pus drained from the abscess grew GAS. Sadly, there were two out of hospital cardiac arrests due to iGAS. The symptoms reported by the parents were similar to a non specific viral infection. One child had clinically significant pre-existing comorbidity. Both children had co-infection with viruses in addition to iGAS. NPA PCR was positive for COVID and metapneumovirus in the first child. NPA PCR was positive for rhinovirus and enterovirus in the second child with co-morbidity. <h3>Conclusions</h3> The 2022–23 unseasonal increase in scarlet fever and iGAS in the paediatric population reported across England¹ was reflected in our Emergency Departments. The reason for the unusual invasiveness of GAS this winter remains a mystery, the emergence of GAS infections at the height of infections with winter viruses is a possible cause. The spectrum of iGAS presentations to this centre varied from pleural empyema to subdural empyema and neck abscess. The children who presented with cardiac arrest had features of sepsis with no history of scarlet fever or sore throat. The vast majority of children who presented with sore throat and scarlet fever to the EDs in this trust had an uneventful course. As always, safety netting when children are discharged from the Emergency Department remains vital. <h3>Reference</h3> Ladhani SN, Guy R, Bhopal SS, Brown CS, Lamagni T, Sharp A. Paediatric group A streptococcal disease in England from October to December, 2022. <i>Lancet Child Adolesc Health</i> 2023 Feb;<b>7</b>(2):e2-e4. doi: 10.1016/S2352-4642(22)00374-1. Epub 2022 Dec 22. PMID: 36566755" @default.
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• W4381250632 date "2023-06-19" @default.
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• W4381250632 title "745 The enigma of the invasiveness of group A streptococcus in children in the winter of 2022–23" @default.
• W4381250632 doi "https://doi.org/10.1136/archdischild-2023-rcpch.39" @default.
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