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PEDIATRICS Vol. 112 No. 1 July 2003, pp. e61-e65

EXPERIENCE AND REASON

A Family Cluster of Five Cases of Group A Streptococcal Pneumonia

Sumita Roy, MD*, Edward L. Kaplan, MD{ddagger}, Benigno Rodriguez, MD§, John R. Schreiber, MD, MPH*,||, Robert A. Salata, MD§, Elizabeth Palavecino, MD|| and Chandy C. John, MD, MS*

* Department of Pediatrics, Rainbow Babies and Children’s Hospital, Case Western Reserve University School of Medicine, Cleveland, Ohio
{ddagger} World Health Organization Collaborating Center for Reference and Research on Streptococci, Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota
§ Department of Medicine University Hospitals of Cleveland and Case Western Reserve University, Cleveland, Ohio
|| Department of Pathology, University Hospitals of Cleveland and Case Western Reserve University, Cleveland, Ohio

A cluster of 5 family members, a mother and 4 children, were hospitalized for severe group A Streptococcus (GAS) pneumonia. Three family members had complications: sepsis (1), empyema (2), and a sterile parapneumonic effusion (1). Two additional family members had symptoms of upper respiratory tract infection, and 1 was hospitalized for these symptoms. GAS was isolated from the blood of 1 patient, the pleural fluid of 2 patients, and the oropharynx of 6 patients. Pulsed field gel electrophoresis testing revealed an identical deoxyribonucleic acid pattern in all 7 isolates. Genotyping revealed the speA gene and serotyping the T-1, M-1 serotype in all isolates. This family cluster of invasive GAS disease is the largest reported to date, with an attack rate of 41.7% (5 of 12 family members). This report provides further support for antibiotic prophylaxis of close contacts of individuals with invasive GAS disease.

Key Words: group A Streptococcus • family • cluster • invasive • pneumonia

Abbreviations: GAS, group A Streptococcus, streptococcal • STSS, streptococcal toxic shock syndrome • RBCH, Rainbow Babies and Children’s Hospital • PFGE, pulsed-field gel electrophoresis • HLA, human histocompatibility leukocyte antigen

Received for publication Dec 26, 2002; Accepted Mar 18, 2003.


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