“We certainly had, as generally happens in the spring period, a very high number of cases of streptococcal infections, which manifested themselves mainly as pharyngotonsillitis. It is a situation that is still present, a very big problem especially for family paediatricians. that we observed in the month of May, also probably due to the atmospheric conditions, is a significant number” of infections of this type. “Now, in the month of June, the number seems more contained. As regards invasive forms, we can say that we are not observing that very significant increase that was highlighted last year. But the cases, albeit in lower numbers, they were certainly higher than those of the pre-Covid era. And predominantly, among the invasive forms, we are mostly observing pneumonia, even complicated by pleural effusion”. Susanna Esposito, professor of Paediatrics at the University of Parma and head of the technical table on infectious diseases and vaccinations of the Italian Society of Paediatrics (Sip), outlined the picture to Adnkronos Salute.
Parents of children attending nursery and primary schools have been able to experience first-hand the impact of ‘spring-like’ streptococcus in action, even just by observing the frequency with which, until recent weeks, warning signs appeared at the entrance. : “We have recorded a case of scarlet fever”, the classic text, which is generally followed in class chats by the communication of further positive swabs. With consequent super work also for family paediatricians. “An indication to remember is to always do the rapid test, not do-it-yourself but the throat swab performed appropriately by the family doctor, because a parent cannot do it well on their own”, warns Esposito.
Because it is important? “The antibiotic in pharyngotonsillitis should be given exclusively when streptococcus is present. Also because – explains the specialist – both Streptococcus pyogenes”, the group A beta hemolytic streptococcus, “but at the same time also the mononucleosis virus are circulating. And if it is true that amoxicillin is the reference drug for streptococcal infection, it should also be remembered that using it improperly if it is mononucleosis can lead to urticarial manifestations”.
Streptococcus has been a ‘special watch’ for a long time now. And today it is back in the spotlight due to an alert launched by nephrologists, based on some retrospective studies conducted in some areas of Italy which indicate that “in the last year, in the pediatric population”, the cases of acute glomerulonephritis have doubled , closely related to the increase in streptococcal infections”. A pathogen with a thousand faces that can reveal itself in many ways, even the most invasive ones. And precisely with regard to invasive forms, Esposito explains that “normally they lead to the need for hospitalization and, consequently, being more serious, when the child is hospitalized he will be treated in the most appropriate way by specialists. Let’s say that there is no possibility of preventing these forms. The only way is to pay attention to the circulation of the infectious agent and of course to prompt treatment if the pathogen is identified.”
These forms have increased after Covid and scientists have conducted several studies to delve deeper into the causes. “It seems that in the post-pandemic phase there is a sort of reduction in protective immunity towards the common genotypes of Streptococcus pyogenes. And there has been an increase in the circulation of viral infections which in itself is a risk factor for invasive infections – observes the expert – And then there is less attention to hand washing. There was also before, however, given the reduced immunity, given the increase in the circulation of viruses that circulated during the lockdown phase less, in fact this increase was observed.” Other hypotheses formulated by experts, such as “the fact that there was a very virulent and diffusible strain, were partly disproved by epidemiological data which studied the genetic part relating to the circulating types. As for sensitivity to beta-lactam antibiotics, it is instead confirmed, which leads us to say that the problem is not antibiotic resistance, another element that was feared.”
Is there an identikit of someone who develops the invasive form? “There is no evidence that certain subjects are more at risk. There are some categories that tend to present an invasive infection more often: children under one year of age, immunosuppressed people, those who have had a recent trauma or a recent surgery. And finally invasive forms can be a complication of chickenpox cases.” The golden rules for prevention, recalls Esposito, are “as always correct hand hygiene, first and foremost; ventilation of internal environments, especially thinking of nursery and primary school classes; and then attention to the sharing of utensils, glasses , personal objects, therefore to promiscuous behavior”.
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