Severe streptococcal complications in varicella

An increase in the incidence of group A beta hemolytic streptococcal (GABHS) infections in children has been recently noted with a frequent association with varicella. Two children, 3 and 4.5 years old, developed varicella. The first one was febrile and presented a phlyctene on his left foot. Few hours after his admission, he presented a septic shock; GABHS was isolated from blood. Despite immediate adapted antibiotherapy, he developed a right tibial osteomyelitis with abscess. The second child also developed varicella and was hospitalized because of fever, bad general condition, right cervical adenitis and edema on the left wrist. Edema rapidly extended to the hand and upper arm. One purulent lesion was noted on the upper arm from whom Staphylococcus aureus and GABHS were isolated. Blood samples were sterile. The clinical course was favorable with adapted antibiotherapy. A cutaneous desquamation was observed on the 9th day and we concluded that it was a GABHS cellulitis. These two cases confirm the recent report of increase in GABHS infections associated with varicella. Such complications must be looked for in patients with varicella remaining abnormally febrile and/or presenting unusual manifestations.