525 - Coinfection of Respiratory Viruses and Group A Streptococcus in Pediatric Population in an Urban Multiethnic Community Hospital

Publication Number: 4513.525

Sana Amreen Shaikh, Flushing Hospital Medical Center, Flushing, NY, United States; Aya Majzoub, Case Western Reserve University, Cleveland, OH, United States; Yasser M. Elhashash, Flushing Hospital Medical Center, brooklyn, NY, United States; Matthew Roland, Medisys Health Network, VALLEY STREAM, NY, United States; Lily Q.. Lew, Flushing Hospital Medical Center, Flushing, NY, United States; Gagan Gulati, Flushing Hospital Medical Center, Flushing, NY, United States

Background: Acute respiratory infections in children are common. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection impacted the epidemiology of acute respiratory infections globally. There are a paucity of studies on the association of respiratory viruses and group A streptococcus (GAS).

Objective: To explore the prevalence of confections of GAS and SARS-CoV-2, GAS and influenza (flu), and GAS and respiratory syncytial virus (RSV).

Design/Methods: A retrospective chart review of children aged 2-18 years that tested positive for GAS, SARS-CoV-2, flu and RSV between Jan 1, 2021 and Dec 31, 2024. Data extracted from EHR included date of visit, demographics (age, gender, ethnicity), clinical presentations, result of rapid antigen detection test (RADT) for GAS, polymerase chain reaction (PCR) for SARS-CoV-2, flu, RSV and other. GAS and SARS-CoV-2, flu and RSV were compared using chi-square, ANOVA for unadjusted bivariate analyses and generalized estimating equations (GEE) for adjusted analyses. Data were analyzed using R software, p< 0.05 was considered statistically significant.

Results: Of 177 charts identified with GAS, SARS-CoV-2, flu and RSV were detected in almost three-quarters (72%, n=127). Of these 127 patients, over a half were male (57%) with a mean (SD) age of 7.7±3.5 years. Majority was of Hispanic ethnicity (83%) reflective of our community. About two-thirds of the patients (68%) were evaluated during the winter months, fewer in the fall (16%) and the least in the summer (4%), χ2=40(6), p< 0.001. The most common coinfection was GAS and flu (70%), followed by GAS and SARS-CoV-2 (17%) and GAS and RSV (13%). Compared to GAS and SARS-CoV-2 using GEE, patients were more likely to test positive for GAS and flu (OR=12.78, 95%CI: 5.61-26.89, p< 0.001) but not for GAS and RSV (OR=0.78, 95%CI: 0.37-1.65, p>0.05). The predominant presenting symptoms were fever (84%) and cough (38%). Of the typical clinical presentations of GAS, sore throat was only in 27%, and 14% each for headache (χ2=3[2], p>0.5), and abdominal pain (χ2=12[2], p=0.002).

Conclusion(s): In our small sample, GAS and flu coinfection was observed most often and identified usually during the winter months in school-aged Hispanic children. Fever and cough were the common presenting symptoms, while classic GAS-associated symptoms were infrequent suggesting initial viral upper respiratory infection followed by GAS infection. These findings highlight the importance of considering GAS coinfection in pediatric patients with viral illnesses, even in the absence of typical GAS symptoms.