PURPOSE AND CONTEXT Streptococcal Infection (SI) is an important cause of pediatric death in children, yet limited reports exist on autopsy findings in fatal SI cases. METHOD Case records (1997-2019) of SI with no pre-existing risk factors were reviewed and selected. Their clinical and pathological findings in the autopsy reports were analyzed. RESULTS In our cohort of 38 cases based on bacterial culture results, SI was most commonly caused by Streptococcus pneumoniae (SPn; 45%) and Streptococcus pyogenes (SPy; 37%). 92% of decedents had some prodromal symptoms prior to terminal presentation. The clinical course was often rapid, with 89% found unresponsive, suddenly collapsing, or dying within 24 hours of hospital admission. 64% of deaths were attributed to sepsis, more frequently diagnosed in the SPy group than in the SPn group (71% vs 48%). Pneumonia was found in both SPn and SPy groups, whereas meningitis was exclusively associated with SPn. CONCLUSION Our study shows fatal SI is most commonly caused by either SPn or SPy, both of which are frequently associated with prodromal symptoms, rapid terminal clinical course, and evidence of sepsis. Postmortem diagnosis of sepsis is challenging and should be correlated with clinical features, bacterial culture results, and autopsy findings.

中文翻译：

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致命的小儿链球菌感染：临床病理学研究。

目的和背景 链球菌感染 (SI) 是儿童儿科死亡的一个重要原因，但关于致命 SI 病例尸检结果的报道有限。方法审查和选择没有预先存在的风险因素的SI病例记录（1997-2019）。分析了他们在尸检报告中的临床和病理结果。结果 根据细菌培养结果，在我们的 38 例病例队列中，SI 最常由肺炎链球菌 (SPn; 45%) 和化脓性链球菌 (SPy; 37%) 引起。92% 的死者在临终前有一些前驱症状。临床过程通常很快，89% 的患者在入院后 24 小时内发现反应迟钝、突然崩溃或死亡。64% 的死亡归因于败血症，SPy 组的诊断率高于 SPn 组（71% 对 48%）。在 SPn 和 SPy 组中均发现了肺炎，而脑膜炎仅与 SPn 相关。结论 我们的研究表明，致命的 SI 最常由 SPn 或 SPy 引起，这两者通常与前驱症状、快速的终末临床过程和败血症的证据有关。脓毒症的尸检诊断具有挑战性，应与临床特征、细菌培养结果和尸检结果相关联。