Published online January 3, 2005
PEDIATRICS Vol. 115 No. 1 January 2005, pp. e112-e114 (doi:10.1542/peds.2004-1336)
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ELECTRONIC ARTICLE

Group A Streptococcal Subdural Empyema as a Complication of Varicella

Rolando Ulloa-Gutierrez, MD, Simon Dobson, MD, FRCPC and John Forbes, MBChB, FRCPC

From the Pediatric Infectious Diseases Division, Department of Pediatrics, British Columbia’s Children’s Hospital, and the University of British Columbia, Vancouver, British Columbia, Canada

Group A ß-hemolytic streptococcus and Staphylococcus aureus are the 2 most common pathogens implicated in secondary invasive bacterial disease after varicella. We describe a 3-month-old male infant from British Columbia, Canada, who presented on day 5 of varicella skin rash with fever, seizures, lethargy, and evidence of intracranial hypertension. A prominent subdural empyema was documented, and Streptococcus pyogenes was recovered from the subdural fluid. Central nervous system bacterial complications should be part of the differential diagnosis for infants and children with chickenpox who present with fever, lethargy, focal seizures, or similar neurologic findings. This case illustrates the importance of universal varicella vaccination to prevent associated bacterial complications of chickenpox.

Key Words: Streptococcus pyogenes • invasive disease • meningitis • subdural empyema • varicella • varicella vaccine • bacterial complications

Abbreviations: GAS, group A streptococcus • CNS, central nervous system • AOM, acute otitis media • BCCH, British Columbia’s Children’s Hospital • VZV, varicella zoster virus • CSF, cerebrospinal fluid

Accepted Aug 4, 2004.


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