J Pediatr Infect Dis 2023; 18(06): 302-309
DOI: 10.1055/s-0043-1771348
Original Article

Life-Threatening Streptococcal Soft Tissue Infections in Children with Chickenpox: A Post-COVID-19 Case Series

Iona McKechnie
1   Department of Plastic Surgery, Evelina London Children's Hospital and St Thomas' Hospital, London, United Kingdom
1   Department of Plastic Surgery, Evelina London Children's Hospital and St Thomas' Hospital, London, United Kingdom
Jana Torres-Grau
1   Department of Plastic Surgery, Evelina London Children's Hospital and St Thomas' Hospital, London, United Kingdom
Jonathan Cohen
2   Department of Paediatric Immunology and Infectious Diseases, Evelina London Children's Hospital and St Thomas' Hospital, London, United Kingdom
Simon Filson
1   Department of Plastic Surgery, Evelina London Children's Hospital and St Thomas' Hospital, London, United Kingdom
› Author Affiliations


Objective Children with chickenpox complicated by soft tissue infections can become critically unwell. We investigated cases that were referred to our center to examine the role of medical and surgical management in their care.

Methods Children presenting with severe soft tissue infections (SSTIs) associated with varicella infections to a tertiary children's hospital in London serving the South East of England were identified. A retrospective review of the patients' records was performed.

Results Ten patients presented having developed severe fever and localized cellulitis at around day 4 of their varicella infection. Group A Streptococcus (GAS) was identified as the causative organism in 90% of cases. Every patient required surgical intervention in addition to medical therapy to establish control of their soft tissue infection. We report 100% survival, and no patients required further reconstructive surgery.

Conclusion SSTIs, often caused by invasive GAS, can severely complicate otherwise innocuous cases of chickenpox. Failure to respond to maximal medical therapy should prompt urgent referral to a specialist center, and early surgical intervention can prevent progression to more serious illness.

Publication History

Received: 14 March 2023

Accepted: 21 June 2023

Article published online:
08 August 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

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