Definitions
Inclusion criteria
- Any child aged 1 month-18 years with probable of confirmed iGAS infection
Confirmed iGAS infection
- Clinical presentation consisent with iGAS AND
- Isolation of group A streptococcus by culture or PCR or antigen detection test from a normally sterile body site
Probable iGAS infection
- Clinical presentation consistent with necrotizing fasciitis or STSS AND
- Isolation of group A streptococcus by culture or PCR or antigen detection test from a non-sterile body site AND
- No evidence of other pathogen explaining the clinical presentation
Clinical presentation consistent with iGAS
- Clinically severe illness, such as sepsis, septic shock, STSS, pneumonia, meningitis, arthritis, osteomyelitis, myositis or necrotizing fasciitis
Index visit
- The visit in which the sample was taken that later turned out positive for group A streptococcus.
- This is not known at the time of visit.
- This is not always the first visit in this disease episode.
Comorbidity
- Simple comorbidity: a chronic underlying condition that is expected to last at least 1 year.
- Complex comorbidity: comorbidity that affects two or more body system, malignancy or a progressive condition.
Streptococcal toxic shock syndrome
Hypotension (systolic blood pressure ≤90 mmHg in adults or <5th percentile for age in children <16 years)
AND
Multiorgan involvement characterized by two or more of the following:
- Renal impairment – In adults, creatinine ≥2 mg/dL (177 micromol/L); in children, ≥2 times the upper limit of normal for age; in patients with pre-existing renal disease, ≥2 times elevation over baseline
- Coagulopathy – Platelets ≤100,000/mm3 (100 x 106/L) or disseminated intravascular coagulation, defined by prolonged clotting times, low fibrinogen level, and the presence of fibrin degradation products
- Liver involvement – Alanine aminotransferase, aspartate aminotransferase, or total bilirubin levels ≥2 times the upper limit of normal for the patient’s age; in patients with pre-existing liver disease, ≥2 times elevation over baseline
- Acute respiratory distress syndrome
- Erythematous macular rash, may desquamate
- Soft tissue necrosis (eg, necrotizing fasciitis, myositis, or gangrene)
AND
Isolation of GAS from a normally sterile site (confirmed case) OR
Isolation of GAS from a normally non-sterile site (probable case)