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Recurrent invasive group A streptococcal infection with four-limb amputation in an immunocompetent child
  1. Nour Gazzaz1,2,
  2. Timothy Mailman1,
  3. Jennifer Ruth Foster1,3
  1. 1Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
  2. 2King Abdulaziz University, Jeddah, Saudi Arabia
  3. 3Critical Care, Dalhousie University, Halifax, Nova Scotia, Canada
  1. Correspondence to Dr Jennifer Ruth Foster, jennifer.foster{at}


We report a previously well paediatric patient with two distinct presentations of invasive group A streptococcus (GAS) infection resulting in significant morbidity. The first episode, following GAS pharyngitis, involved multiorgan dysfunction syndrome. This included cardiorespiratory and acute hepatorenal failure and purpura fulminans that eventually necessitated four-limb amputation. The second episode occurred 12 months later, from undetermined aetiology, and resulted in septic shock. Molecular analysis of the emm gene and PCR for Serum Opacity Factor revealed that the initial isolate was M Type 4 and sof gene positive while the second isolate was M Type 1 and sof gene negative. Immunological investigations, including CH50, quantitative IgA, IgM and IgG, and flow cytometry measuring lymphocyte subsets, and vaccine response to measles, mumps, rubella and pneumococcus were normal. This is the first report of recurrent bacteraemia from different strains of Streptococcus pyogenes infection in an apparently immunocompetent child.

  • drugs: infectious diseases
  • bone and joint infections
  • paediatric intensive care
  • immunology
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  • Contributors All authors contributed significantly to this manuscript. NG wrote the initial draft. JRF provided edits and critically altered the discussion. TM provided input on immunological and infection-related topics. All authors have seen and approved the manuscript as submitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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