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Malik A, Mahajan N, Dar TA, Kim CB. C10Pred: A First Machine Learning Based Tool to Predict C10 Family Cysteine Peptidases Using Sequence-Derived Features. Int J Mol Sci 2022; 23:ijms23179518. [PMID: 36076915 PMCID: PMC9455582 DOI: 10.3390/ijms23179518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/17/2022] [Accepted: 08/20/2022] [Indexed: 12/02/2022] Open
Abstract
Streptococcus pyogenes, or group A Streptococcus (GAS), a gram-positive bacterium, is implicated in a wide range of clinical manifestations and life-threatening diseases. One of the key virulence factors of GAS is streptopain, a C10 family cysteine peptidase. Since its discovery, various homologs of streptopain have been reported from other bacterial species. With the increased affordability of sequencing, a significant increase in the number of potential C10 family-like sequences in the public databases is anticipated, posing a challenge in classifying such sequences. Sequence-similarity-based tools are the methods of choice to identify such streptopain-like sequences. However, these methods depend on some level of sequence similarity between the existing C10 family and the target sequences. Therefore, in this work, we propose a novel predictor, C10Pred, for the prediction of C10 peptidases using sequence-derived optimal features. C10Pred is a support vector machine (SVM) based model which is efficient in predicting C10 enzymes with an overall accuracy of 92.7% and Matthews’ correlation coefficient (MCC) value of 0.855 when tested on an independent dataset. We anticipate that C10Pred will serve as a handy tool to classify novel streptopain-like proteins belonging to the C10 family and offer essential information.
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Affiliation(s)
- Adeel Malik
- Institute of Intelligence Informatics Technology, Sangmyung University, Seoul 03016, Korea
- Correspondence: (A.M.); (C.-B.K.)
| | - Nitin Mahajan
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO 63110, USA
| | - Tanveer Ali Dar
- Department of Clinical Biochemistry, University of Kashmir, Srinagar 190006, India
| | - Chang-Bae Kim
- Department of Biotechnology, Sangmyung University, Seoul 03016, Korea
- Correspondence: (A.M.); (C.-B.K.)
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Sumiyama F, Sakaguchi T, Yamamichi K, Sekimoto M. Peritonitis caused by group A streptococcus: A case report and literature review. Int J Surg Case Rep 2022; 92:106839. [PMID: 35240481 PMCID: PMC8889339 DOI: 10.1016/j.ijscr.2022.106839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/01/2022] [Accepted: 02/13/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Group A streptococcus (GAS) occasionally causes life-threatening infections. We encountered a case of GAS peritonitis associated with bilateral salpingitis. CASE PRESENTATION A 56-year-old previously healthy woman suddenly experienced a fever of 40 °C and lower abdominal pain, and was taken to the emergency room. She exhibited a condition of severe sepsis with pan-peritonitis. Although an intra-peritoneal source of infection was not detected preoperatively, an exploratory laparotomy was performed at 3 h after her arrival. During the surgery, bilateral salpingitis was observed. Peritoneal drainage was performed. Meropenem was administered and she was extubated on the next day. GAS was detected in the vaginal fluid culture and ascitic fluid culture. Antibiotics therapy was completed on postoperative day 9 and the patient was discharged on day 10 without any complications. METHODS A literature review was performed using the following algorithm: "(group A streptococcus OR streptococcus pyogenes) AND (peritonitis)". All case reports and case series published in English after 1990 were reviewed. RESULTS Fifty-six reports including 65 cases were eligible. There was a strong sex difference, with 80% of cases being female. All patients had symptoms of peritonitis, 80% had high-grade fever, and 74% had shock. The average time from onset to start of treatment was 3.8 days. Abdominal surgeries were required in 80% of cases. Multiple organ failure developed in 23%, and the mortality rate was 4.6%. DISCUSSION GAS peritonitis is a rare but life-threatening disease. Emergency surgical exploration and drainage are required to prevent progression to multiple organ failure.
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Affiliation(s)
- Fusao Sumiyama
- Department of Surgery, Kansai Medical University, Osaka, Japan
| | | | - Keigo Yamamichi
- Department of Surgery, Kansai Medical University, Osaka, Japan
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Piastra M, Ferrari V, Picconi E, Morena TC, Pezza L, De Rosa G, Fedele MC, Genovese O, Onesimo R, Tempera A, Valentini P, Buonsenso D, Visconti F, Zito G, Benassi C, Conti G. Life-threatening complications of streptococcal sepsis: a PICU contemporary series. JOURNAL OF ANESTHESIA, ANALGESIA AND CRITICAL CARE 2021. [PMCID: PMC8669399 DOI: 10.1186/s44158-021-00028-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Life-threatening streptococcal sepsis nowadays represents an uncommon event in previously healthy infants and children. Critically ill patients suffering from severe streptococcal sepsis complications may present with pre-antibiotic era clinical pictures and require a timely clinical approach to achieve restitutio ad integrum.
Results
We report a series of four patient groups affected by an uncommon life-threatening streptococcal sepsis, each of them exhibiting some distinct features. Streptococcus Agalactiae sepsis was associated with cerebral thrombotic/ischaemic lesions, whereas severe cardiogenic shock was prominent in the Streptococcus Viridans group; Streptococcus Faecalis and β-hemolytic group A Streptococcus patients mostly reported lung complications.
Conclusions
Previous antibiotic treatments should not delay aggressive treatment in the intensive care setting. Early diagnostic suspicion, as well as appropriate and aggressive treatment provided within an intensive care setting are crucial for the clinical outcome.
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4
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Degala S, Puleston R, Bates R, Borges-Stewart R, Coelho J, Kapatai G, Chalker V, Mair-Jenkins J. A protracted iGAS outbreak in a long-term care facility 2014-2015: control measures and the use of whole-genome sequencing. J Hosp Infect 2021; 105:70-77. [PMID: 32386676 DOI: 10.1016/j.jhin.2019.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/04/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND In 2014, two residents of a long-term care facility (LTCF) developed invasive group A streptococcal (iGAS) infections with identical typing (emm 11), resulting in one death. The second resident recovered but had a subsequent episode of emm 11 iGAS infection 10 months later. This second episode was linked to a third case, within 12 days, leading to a further outbreak investigation. AIM To combine different techniques to establish whether this was a protracted outbreak, understand transmission pathways and inform appropriate control measures. METHODS Following a routine response to the first cluster, the second investigation included a care record review. This informed network analysis of case interactions with staff and visitors during 10 days prior to infection. These data were combined with post-outbreak whole-genome sequencing (WGS) using isolates from cases, and staff and resident screening (44 GAS isolates: 11 outbreak-related and 33 sporadic isolates). FINDINGS Two of the three confirmed iGAS cases died (one suffered two episodes). All iGAS cases, and six non-invasive isolates from 2015, were emm 11 (monophylogenetic WGS clade). Network analysis highlighted only indirect contact through staff-visitor interactions between iGAS cases in 2015. This suggested a common source and transmission propagation through carriage and/or environmental contamination over an 11-month period. CONCLUSIONS This outbreak highlighted benefits of staff/resident screening and typing as part of routine response. Network analysis and highly discriminatory WGS clarified the protracted nature of the outbreak, supporting findings of hygiene and infection control issues and adding to our understanding of the epidemiology.
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Affiliation(s)
- S Degala
- Field Epidemiology, Field Service, National Infection Service, Public Health England, Nottingham, UK.
| | - R Puleston
- Field Epidemiology, Field Service, National Infection Service, Public Health England, Nottingham, UK
| | - R Bates
- Local Knowledge and Intelligence Service, Public Health England, Nottingham, UK
| | | | - J Coelho
- Respiratory and Systemic Bacteria Section, Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England, Nottingham, UK
| | - G Kapatai
- Respiratory and Systemic Bacteria Section, Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England, Nottingham, UK
| | - V Chalker
- Respiratory and Systemic Bacteria Section, Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England, Nottingham, UK
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5
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Morshedtalab Z, Rahimi G, Emami-Nejad A, Farasat A, Mohammadbeygi A, Ghaedamini N, Negahdary M. Antibacterial Assessment of Zinc Sulfide Nanoparticles against Streptococcus pyogenes and Acinetobacter baumannii. Curr Top Med Chem 2021; 20:1042-1055. [PMID: 32250224 DOI: 10.2174/1381612826666200406095246] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 12/13/2019] [Accepted: 03/06/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Due to the appearance of resistant bacterial strains against the antimicrobial drugs and the reduced efficiency of these valuable resources, the health of a community and the economies of countries have been threatened. OBJECTIVE In this study, the antibacterial assessment of zinc sulfide nanoparticles (ZnS NPs) against Streptococcus pyogenes and Acinetobacter baumannii has been performed. METHODS ZnS NPs were synthesized through a co-precipitation method using polyvinylpyrrolidone (PVP), polyvinyl alcohol (PVA) and polyethylene glycol (PEG-4000). The size and morphology of the synthesized ZnS NPs were determined by a scanning electron microscope (SEM) and it was found that the average size of the applied NPs was about 70 nm. In order to evaluate the antibacterial effect of the synthesized ZnS NPs, various concentrations (50μg/mL, 100 μg/mL and 150 μg/mL) of ZnS NPs were prepared. Antibacterial assessments were performed through the disc diffusion method in Mueller Hinton Agar (MHA) culture medium and also the optical density (OD) method was performed by a UV-Vis spectrophotometer in Trypticase™ Soy Broth (TSB) medium. Then, in order to compare the antibacterial effects of the applied NPs, several commercial antibiotics including penicillin, amikacin, ceftazidime and primaxin were used. RESULTS The achieved results indicated that the antibacterial effects of ZnS NPs had a direct relation along with the concentrations and the concentration of 150 μg/mL showed the highest antibacterial effect in comparison with others. In addition, the ZnS NPs were more effective on Acinetobacter baumannii. CONCLUSION The findings of this research suggest a novel approach against antibiotic resistance.
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Affiliation(s)
| | - Ghasem Rahimi
- Agro Industrial Complex of Medicinal Plants ( SPAD), Shiraz, Iran
| | - Asieh Emami-Nejad
- Department of Biology, Payame Noor University (PNU), P.O.Box 19395-3697, Tehran, Iran
| | - Alireza Farasat
- Cellular and Molecular Research Center, Research Institute for prevention of Non- Communicable Disease, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Azita Mohammadbeygi
- Department of Immunology, Shahid Beheshti International University, Tehran, Iran
| | - Nahid Ghaedamini
- Department of Biology, Payame Noor University (PNU), P.O.Box 19395-3697, Tehran, Iran
| | - Masoud Negahdary
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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6
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Gajdács M, Ábrók M, Lázár A, Burián K. Beta-Haemolytic Group A, C and G Streptococcal Infections in Southern Hungary: A 10-Year Population-Based Retrospective Survey (2008-2017) and a Review of the Literature. Infect Drug Resist 2021; 13:4739-4749. [PMID: 33408489 PMCID: PMC7781025 DOI: 10.2147/idr.s279157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/18/2020] [Indexed: 01/06/2023] Open
Abstract
Introduction Pyogenic β-hemolytic streptococci (including Group A, C and G Streptococcus) are some of the most important Gram-positive bacterial pathogens in human medicine. Although effective therapy is available, invasive streptococcal infections are associated with a significant disease burden. Methods In this retrospective study, the epidemiological characteristics of invasive Group A (iGAS) and Group C and G (iGCGS) streptococci, along with tonsillo-pharyngitis-causing pGAS and pGCGS infections, were assessed in Southern Hungary. A total of 1554 cases of streptococcal tonsillo-pharyngitis infections (26.5–44.1/100,000 persons, pGAS: 95.5%; n=1484) and 1104 cases of invasive streptococcal infections were detected (12.5–31.4/100,000 persons, iGAS: 77.9%; n=861). Results The average age of the affected patients in the various groups were the following: pGAS: 13.2±13.1 years, pGCGS: 21.0±15.0 years (p=0.039), iGAS: 49.1±12.8 years, iGCGS: 58.7±18.5 years (p>0.05). iGAS isolates originated from abscesses (47.1%), blood culture samples (24.1%), surgical samples (16.7%), biopsies (4.6%), pleural fluid (3.5%), pus (2.0%), synovial fluid (1.3%) and cerebrospinal fluid samples (0.7%). In contrast, iGCGS isolates mainly originated from blood culture samples (53.8%), abscesses (22.9%), surgical samples (12.3%), synovial fluid (5.1%), pleural fluid (3.7%), pus (1.8%) and cerebrospinal fluid samples (0.4%). All respective isolates were susceptible to benzyl-penicillin; overall resistance levels for erythromycin (10.5% for GAS, 21.4% for GCGS) and clindamycin (9.2% for GAS, 17.2% for GCGS) were significantly higher in GCGS isolates, while resistance levels for norfloxacin were higher in GAS isolates (13.5% for GAS, 6.9% for GCGS). Conclusion The rates of resistance to macrolides and clindamycin are a cause for concern (especially among GCGS isolates); however, resistance levels are still relatively low, compared to Southern European countries.
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Affiliation(s)
- Márió Gajdács
- Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, Szeged 6720, Hungary
| | - Marianna Ábrók
- Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Andrea Lázár
- Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Katalin Burián
- Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, Szeged, Hungary.,Department of Medical Microbiology, Faculty of Medicine, University of Szeged, Szeged 6720, Hungary
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7
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Boukthir S, Moullec S, Cariou ME, Meygret A, Morcet J, Faili A, Kayal S. A prospective survey of Streptococcus pyogenes infections in French Brittany from 2009 to 2017: Comprehensive dynamic of new emergent emm genotypes. PLoS One 2020; 15:e0244063. [PMID: 33332468 PMCID: PMC7746304 DOI: 10.1371/journal.pone.0244063] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/02/2020] [Indexed: 12/15/2022] Open
Abstract
Streptococcus pyogenes or group A Streptococcus (GAS) causes diseases ranging from uncomplicated pharyngitis to life-threatening infections. It has complex epidemiology driven by the diversity, the temporal and geographical fluctuations of the circulating strains. Despite the global burden of GAS diseases, there is currently no available vaccination strategy against GAS infections. This study, based on a longitudinal population survey, aimed to understand the dynamic of GAS emm types and to give leads to better recognition of underlying mechanisms for the emergence of successful clones. From 2009 to 2017, we conducted a systematic culture-based diagnosis of GAS infections in a French Brittany population with a prospective recovery of clinical data. The epidemiological analysis was performed using emm typing combined with the structural and functional cluster-typing system for all the recovered strains. Risk factors for the invasiveness, identified by univariate analysis, were computed in a multiple logistic regression analysis, and the only independent risk factor remaining in the model was the age (OR for the entire range [CI95%] = 6.35 [3.63, 11.10]; p<0.0001). Among the 61 different emm types identified, the most prevalent were emm28 (16%), emm89 (15%), emm1 (14%), and emm4 (8%), which accounted for more than 50% of circulating strains. During the study period, five genotypes identified as emm44, 66, 75, 83, 87 emerged successively and belonged to clusters D4, E2, E3, and E6 that were different from those gathering “Prevalent” emm types (clusters A-C3 to 5, E1 and E4). We previously reported significant genetic modifications for emm44, 66, 83 and 75 types resulting possibly from a short adaptive evolution. Herein we additionally observed that the emergence of a new genotype could occur in a susceptible population having specific risk factors or probably lacking a naturally-acquired cluster-specific immune cross-protection. Among emergent emm types, emm75 and emm87 tend to become prevalent with a stable annual incidence and the risk of a clonal expansion have to be considered.
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Affiliation(s)
- Sarrah Boukthir
- CHU de Rennes, Service de Bactériologie-Hygiène Hospitalière, Rennes, France
- Inserm, CIC 1414, Rennes, France
- Université Rennes 1, Faculté de Médecine, Rennes, France
| | - Séverine Moullec
- Inserm, CIC 1414, Rennes, France
- Université Rennes 1, Faculté de Médecine, Rennes, France
| | | | - Alexandra Meygret
- CHU de Rennes, Service de Bactériologie-Hygiène Hospitalière, Rennes, France
- Université Rennes 1, Faculté de Médecine, Rennes, France
| | - Jeff Morcet
- CHU de Rennes, Service de Bactériologie-Hygiène Hospitalière, Rennes, France
- Inserm, CIC 1414, Rennes, France
| | - Ahmad Faili
- Inserm, CIC 1414, Rennes, France
- Université Rennes 1, Faculté de Pharmacie, Rennes, France
| | - Samer Kayal
- CHU de Rennes, Service de Bactériologie-Hygiène Hospitalière, Rennes, France
- Inserm, CIC 1414, Rennes, France
- Université Rennes 1, Faculté de Médecine, Rennes, France
- * E-mail:
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8
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DeWyer A, Scheel A, Webel AR, Longenecker CT, Kamarembo J, Aliku T, Engel ME, Bowen AC, Bwanga F, Hovis I, Chang A, Sarnacki R, Sable C, Dale JB, Carapetis J, Rwebembera J, Okello E, Beaton A. Prevalence of group A β-hemolytic streptococcal throat carriage and prospective pilot surveillance of streptococcal sore throat in Ugandan school children. Int J Infect Dis 2020; 93:245-251. [PMID: 31972290 DOI: 10.1016/j.ijid.2020.01.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 01/13/2020] [Accepted: 01/13/2020] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES Group A β-hemolytic Streptococcus (GAS), also known as Streptococcus pyogenes, is responsible for an annual 600 million cases of acute pharyngitis globally, with 92% of those infections occurring in low-resource settings. Further knowledge of the acute streptococcal pharyngitis burden in low-resource settings is essential if serious post-streptococcal complications - rheumatic fever (RF) and its long-term sequel rheumatic heart disease (RHD) - are to be prevented. METHODS Two studies were conducted in school-aged children (5-16 years): a cross-sectional study of streptococcal pharyngeal carriage followed by a prospective cohort study of streptococcal sore throat over 4 weeks from March to April 2017. RESULTS The cross-sectional study revealed an overall prevalence of GAS carriage of 15.9% (79/496, 95% confidence interval 12.8-19.5%). Among 532 children enrolled in the prospective cohort study, 358 (67%) reported 528 sore throats, with 221 (41.1%) experiencing at least one GAS-positive sore throat. The overall GAS-positive rate for sore throat was 41.8% (221/528). CONCLUSIONS The GAS pharyngeal carriage rates seen in Uganda (15.9%, 95% confidence interval 12.8-19.5%) are higher than the most recent pooled results globally, at 12% (range 6-28%). Additionally, pilot data suggest a substantially higher percentage of sore throat that was GAS-positive (41.8%) compared to pooled global rates when active recruitment is employed.
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Affiliation(s)
- Alyssa DeWyer
- Children's National Health System, Department of Cardiology 111 Michigan Ave NW, Washington DC, USA.
| | - Amy Scheel
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Allison R Webel
- Frances Payne Bolton School of Nursing Case Western Reserve University, Cleveland, Ohio
| | - Chris T Longenecker
- University Hospitals Harrington Heart & Vascular Institute, Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Twalib Aliku
- Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Mark E Engel
- Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - Asha C Bowen
- University of Western Australia, Perth, WA; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA; Perth Children's Hospital, Perth, WA
| | - Freddie Bwanga
- Department of Medical Microbiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ian Hovis
- Children's National Health System, Department of Cardiology 111 Michigan Ave NW, Washington DC, USA
| | - Aileen Chang
- Department of Dermatology, University of California, San Francisco, 505 Paranassus Avenue, San Francisco, CA, 94143, USA
| | - Rachel Sarnacki
- Children's National Health System, Department of Cardiology 111 Michigan Ave NW, Washington DC, USA
| | - Craig Sable
- Children's National Health System, Department of Cardiology 111 Michigan Ave NW, Washington DC, USA
| | - James B Dale
- Medicine, University of Tennessee, Memphis, TN, USA
| | - Jonathan Carapetis
- University of Western Australia, Perth, WA; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, WA; Perth Children's Hospital, Perth, WA
| | | | - Emmy Okello
- Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Andrea Beaton
- Cincinnati Children's Hospital Medical Center, Cincinnati Ohio, USA
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9
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Del Rosal T, Caminoa MB, González-Guerrero A, Falces-Romero I, Romero-Gómez MP, Baquero-Artigao F, Sainz T, Méndez-Echevarría A, Escosa-García L, Aracil FJ, Calvo C. Outcome of Severe Bacterial Pneumonia in the Era of Pneumococcal Vaccination. Front Pediatr 2020; 8:576519. [PMID: 33384973 PMCID: PMC7769833 DOI: 10.3389/fped.2020.576519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 11/27/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: After the introduction of pneumococcal conjugate vaccines, community-acquired pneumonia (CAP) caused by Streptococcus pneumoniae has decreased whereas Staphylococcus aureus and Streptococcus pyogenes could be increasing. These bacteria have been associated with high rates of complications. Aims: (1) To describe the characteristics of pediatric bacterial CAP requiring hospitalization. (2) To compare outcomes according to causative microorganisms. (3) To analyze changes in bacterial CAP rate and etiology over time. Patients and Methods: Retrospective single-center study of inpatients aged 1 month-16 years with culture-confirmed bacterial CAP in 2010-2018 in Madrid, Spain. Results: We included 64 cases (42 S. pneumoniae, 13 S. pyogenes and 9 S. aureus). Culture-confirmed CAP represented 1.48-2.33/1,000 all-cause pediatric hospital admissions, and its rate did not vary over time. However, there was a significant decrease in pneumococcal CAP in the last 3 years of the study (78% of CAP in 2010-2015 vs. 48% in 2016-18, p = 0.017). Median hospital stay was 10.5 days (interquartile range 5-19.5), 38 patients (59%) developed complications and 28 (44%) were admitted to the intensive care unit. Outcomes were similar among children with S. pneumoniae and S. aureus CAP, whereas S. pyogenes was associated with a higher risk for complications (OR 8 [95%CI 1.1-57.2]) and ICU admission (OR 7.1 [95%CI 1.7-29.1]) compared with pneumococcal CAP. Conclusion: In a setting with high PCV coverage, culture-confirmed bacterial CAP did not decrease over time and there was a relative increase of S. pyogenes and S. aureus. Children with CAP caused by S. pyogenes were more likely to develop complications.
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Affiliation(s)
- Teresa Del Rosal
- Department of Pediatric Infectious Diseases, Hospital Universitario La Paz and IdiPAZ Research Institute, Madrid, Spain
| | | | - Alba González-Guerrero
- Department of Pediatric Infectious Diseases, Hospital Universitario La Paz and IdiPAZ Research Institute, Madrid, Spain
| | - Iker Falces-Romero
- Department of Microbiology, Hospital Universitario La Paz, Madrid, Spain
| | | | - Fernando Baquero-Artigao
- Department of Pediatric Infectious Diseases, Hospital Universitario La Paz and IdiPAZ Research Institute, Madrid, Spain
| | - Talía Sainz
- Department of Pediatric Infectious Diseases, Hospital Universitario La Paz and IdiPAZ Research Institute, Madrid, Spain.,Red de Investigación Traslacional en Infectología Pediátrica, Madrid, Spain
| | - Ana Méndez-Echevarría
- Department of Pediatric Infectious Diseases, Hospital Universitario La Paz and IdiPAZ Research Institute, Madrid, Spain
| | - Luis Escosa-García
- Department of Pediatric Infectious Diseases, Hospital Universitario La Paz and IdiPAZ Research Institute, Madrid, Spain
| | - Francisco Javier Aracil
- Department of Pediatric Infectious Diseases, Hospital Universitario La Paz and IdiPAZ Research Institute, Madrid, Spain
| | - Cristina Calvo
- Department of Pediatric Infectious Diseases, Hospital Universitario La Paz and IdiPAZ Research Institute, Madrid, Spain.,Red de Investigación Traslacional en Infectología Pediátrica, Madrid, Spain
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10
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Neilly DW, Smith M, Woo A, Bateman V, Stevenson I. Necrotising fasciitis in the North East of Scotland: a 10-year retrospective review. Ann R Coll Surg Engl 2019; 101:363-372. [PMID: 30855976 DOI: 10.1308/rcsann.2019.0013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Necrotising fasciitis is a life-threatening rapidly progressing bacterial infection of the skin requiring prompt diagnosis and treatment. Optimum care warrants a combination of surgical debridement, antibiotics and intensive care support. All cases of necrotising fasciitis in 10 years in the North East of Scotland were reviewed to investigate and improve patient care. METHODS Cases between August 2006 and February 2016 were reviewed using case notes and electronic hospital records. Data including mode of admission, clinical observations, investigations, operative interventions, microbiological and clinical outcomes was collected and reviewed. Analysis required multidisciplinary input including microbiology, infectious disease, trauma and orthopaedics, plastic surgery and intensive care teams. RESULTS A total of 36 cases were identified. The mean laboratory risk indicator for necrotising fasciitis (LRINEC) score was 7 and 86% of patients fulfilled the criteria for necrotising fasciitis. Patients were commonly haemodynamically stable upon admission but deteriorated rapidly; 36% of patients had a temperature of over 37.5 degrees C on initial observations; 29/36 patients were discharged, 6 patients died acutely (acute mortality rate of 17%); 18/31 of cases were polymicrobial with Streptococcus pyogenes, the common organism. Six amputations or disarticulations were performed from a total of 82 operations in this group, with radical debridement the usual primary operation. The mean time to theatre was 3.54 hours. Highly elevated admission respiratory rate (50 breaths/minute) was associated with increased mortality. CONCLUSIONS Necrotising fasciitis presents subtly and carries significant morbidity and mortality. A high index of suspicion allows early diagnosis and intervention. We believe that a pan-specialty approach is the cornerstone for good outcomes.
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Affiliation(s)
- D W Neilly
- Department of Trauma and Orthopaedics, Aberdeen Royal Infirmary , Aberdeen , UK
| | - M Smith
- Department of Trauma and Orthopaedics, Aberdeen Royal Infirmary , Aberdeen , UK
| | - A Woo
- Department of Trauma and Orthopaedics, Aberdeen Royal Infirmary , Aberdeen , UK
| | - V Bateman
- Department of Microbiology, Aberdeen Royal Infirmary , Aberdeen , UK
| | - I Stevenson
- Department of Trauma and Orthopaedics, Aberdeen Royal Infirmary , Aberdeen , UK
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Schmitz M, Roux X, Huttner B, Pugin J. Streptococcal toxic shock syndrome in the intensive care unit. Ann Intensive Care 2018; 8:88. [PMID: 30225523 PMCID: PMC6141408 DOI: 10.1186/s13613-018-0438-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 09/11/2018] [Indexed: 11/10/2022] Open
Abstract
The streptococcal toxic shock syndrome is a severe complication associated with invasive infections by group A streptococci. In spite of medical progresses in the care of patients with septic shock during the last decades, this condition has remained associated with a high mortality. Early recognition and multidisciplinary management are key to the care of patients with streptococcal toxic shock syndrome, with intensive and appropriate intensive support of failing organs, rapid diagnosis of infectious source(s), and surgical management. The epidemiology and risk factors for streptococcal toxic shock syndrome remain to be better studied, including the possible causal role of exposure to nonsteroidal anti-inflammatory drugs. In this review article, the authors review the current knowledge of streptococcal toxic shock syndrome and discuss the pathophysiology as well as its supportive and specific treatment.
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Affiliation(s)
- Marylin Schmitz
- Division of Intensive Care, Faculty of Medicine Geneva, University Hospitals of Geneva, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland
| | - Xavier Roux
- Division of Intensive Care, Faculty of Medicine Geneva, University Hospitals of Geneva, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland
| | - Benedikt Huttner
- Division of Infectious Diseases, Faculty of Medicine Geneva, University Hospitals of Geneva, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland
| | - Jérôme Pugin
- Division of Intensive Care, Faculty of Medicine Geneva, University Hospitals of Geneva, University of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland
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Gherardi G, Vitali LA, Creti R. Prevalent emm Types among Invasive GAS in Europe and North America since Year 2000. Front Public Health 2018; 6:59. [PMID: 29662874 PMCID: PMC5890186 DOI: 10.3389/fpubh.2018.00059] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 02/14/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Streptococcus pyogenes or group A streptococcus (GAS) is an important human pathogen responsible for a broad range of infections, from uncomplicated to more severe and invasive diseases with high mortality and morbidity. Epidemiological surveillance has been crucial to detect changes in the geographical and temporal variation of the disease pattern; for this purpose the M protein gene (emm) gene typing is the most widely used genotyping method, with more than 200 emm types recognized. Molecular epidemiological data have been also used for the development of GAS M protein-based vaccines. METHODS The aim of this paper was to provide an updated scenario of the most prevalent GAS emm types responsible for invasive infections in developed countries as Europe and North America (US and Canada), from 1st January 2000 to 31st May 2017. The search, performed in PubMed by the combined use of the terms ("emm") and ("invasive") retrieved 264 articles, of which 38 articles (31 from Europe and 7 from North America) met the inclusion criteria and were selected for this study. Additional five papers cited in the European articles but not retrieved by the search were included. RESULTS emm1 represented the dominant type in both Europe and North America, replaced by other emm types in only few occasions. The seven major emm types identified (emm1, emm28, emm89, emm3, emm12, emm4, and emm6) accounted for approximately 50-70% of the total isolates; less common emm types accounted for the remaining 30-50% of the cases. Most of the common emm types are included in either one or both the 26-valent and 30-valent vaccines, though some well-represented emm types found in Europe are not. CONCLUSION This study provided a picture of the prevalent emm types among invasive GAS (iGAS) in Europe and North America since the year 2000 onward. Continuous surveillance on the emm-type distribution among iGAS infections is strongly encouraged also to determine the potential coverage of the developing multivalent vaccines.
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Affiliation(s)
- Giovanni Gherardi
- Microbiology Unit, Department of Medicine, Campus Bio-Medico University, Rome, Italy
| | | | - Roberta Creti
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
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Imöhl M, Fitzner C, Perniciaro S, van der Linden M. Epidemiology and distribution of 10 superantigens among invasive Streptococcus pyogenes disease in Germany from 2009 to 2014. PLoS One 2017; 12:e0180757. [PMID: 28719668 PMCID: PMC5515411 DOI: 10.1371/journal.pone.0180757] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 06/21/2017] [Indexed: 11/18/2022] Open
Abstract
A nationwide laboratory-based surveillance study of invasive S. pyogenes infections was conducted in Germany. Invasive isolates (n = 719) were obtained between 2009 and 2014. Most isolates were obtained from blood (92.1%). The proportions of isolates from cerebrospinal fluid, pleural fluid, synovial fluid and peritoneal fluid were 3.9%, 1.8%, 1.7% and 0.6%, respectively. The most common emm types were emm 1 (31.8%), emm 28 (15.4%) and emm 89 (14.5%). The most common superantigen genes (speA, speC, speG, speH, speI, speJ, speK, speL, speM, ssa) identified from S. pyogenes were speG (92.1%), speJ (50.9%), and speC (42.0%). Significant associations of superantigen genes with underlying conditions or risks were observed in speG, speH, speJ, and speK. Significant associations between emm types or superantigen genes with clinical complications were observed in emm type 3 and in superantigen gene speA 1-3. Most frequent clinical manifestations included sepsis 59.4%, STSS 6.3%, meningitis 5.4%, and necrotizing fasciitis 5.0% (significantly associated with emm1).
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Affiliation(s)
- Matthias Imöhl
- Institute of Medical Microbiology and National Reference Center for Streptococci, University Hospital (RWTH), Aachen, Germany
- * E-mail:
| | - Christina Fitzner
- Department of Medical Statistics, University Hospital (RWTH), Aachen, Germany
| | - Stephanie Perniciaro
- Institute of Medical Microbiology and National Reference Center for Streptococci, University Hospital (RWTH), Aachen, Germany
| | - Mark van der Linden
- Institute of Medical Microbiology and National Reference Center for Streptococci, University Hospital (RWTH), Aachen, Germany
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Bellulo S, Sommet J, Lévy C, Gillet Y, Hees L, Lorrot M, Gras-Le-Guen C, Craiu I, Dubos F, Minodier P, Biscardi S, Dommergues MA, Béchet S, Bidet P, Alberti C, Cohen R, Faye A. When should clinicians suspect group A streptococcus empyema in children? A multicentre case-control study in French tertiary care centres. Arch Dis Child 2016; 101:731-5. [PMID: 27073159 DOI: 10.1136/archdischild-2015-309831] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 03/22/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND The incidence of invasive group A streptococcus (GAS) infections is increasing worldwide, whereas there has been a dramatic decrease in pneumococcal invasive diseases. Few data describing GAS pleural empyema in children are available. OBJECTIVE To describe the clinical and microbiological features, management and outcome of GAS pleural empyema in children and compare them with those of pneumococcal empyema. DESIGN, SETTING AND PATIENTS Fifty children admitted for GAS pleural empyema between January 2006 and May 2013 to 8 hospitals participating in a national pneumonia survey were included in a descriptive study and matched by age and centre with 50 children with pneumococcal empyema. RESULTS The median age of the children with GAS pleural empyema was 2 (range 0.1-7.6) years. Eighteen children (36%) had at least one risk factor for invasive GAS infection (corticosteroid use and/or current varicella). On admission, 37 patients (74%) had signs of circulatory failure, and 31 (62%) had a rash. GAS was isolated from 49/50 pleural fluid samples and from one blood culture. The commonest GAS genotype was emm1 (n=17/22). Two children died (4%). Children with GAS empyema presented more frequently with a rash (p<0.01), signs of circulatory failure (p=0.01) and respiratory disorders (p=0.02) and with low leucocyte levels (p=0.04) than children with pneumococcal empyema. Intensive care unit admissions (p<0.01), drainage procedures (p=0.04) and short-term complications (p=0.01) were also more frequent in patients with GAS empyema. CONCLUSIONS Pleural empyema following varicella or presenting with rash, signs of circulatory failure and leucopenia may be due to GAS. These features should prompt the addition to treatment of an antitoxin drug, such as clindamycin.
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Affiliation(s)
| | - Julie Sommet
- INSERM, U 1123, ECEVE, CIC-EC 1426 Hôpital Robert Debré, Paris, France Department of General Pediatrics, CHU Robert Debré, Paris and University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Corinne Lévy
- ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France
| | - Yves Gillet
- ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France Department of Pediatrics, CHU Lyon-Bron and Lyon University, Hospices Civils de Lyon, Lyon, France
| | - Laure Hees
- ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France Department of Pediatrics, CHU Lyon-Bron and Lyon University, Hospices Civils de Lyon, Lyon, France
| | - Mathie Lorrot
- INSERM, U 1123, ECEVE, CIC-EC 1426 Hôpital Robert Debré, Paris, France Department of General Pediatrics, CHU Robert Debré, Paris and University Paris Diderot, Sorbonne Paris Cité, Paris, France ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France
| | - Christèle Gras-Le-Guen
- ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France Department of Pediatrics, CHU Nantes and University of Nantes, Nantes, France
| | - Irina Craiu
- ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France Department of Pediatrics, CHU Kremlin-Bicêtre, Le Kremlin Bicêtre, France
| | - François Dubos
- ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France Pediatric Emergency Unit and Infectious Diseases, CHRU Lille and University of Lille, Lille, France
| | - Philippe Minodier
- Department of Pediatrics, CHU Nord, Marseille, France ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France
| | - Sandra Biscardi
- ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France Department of Pediatrics, CHIC Créteil, Créteil, France
| | - Marie-Aliette Dommergues
- ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France Department of Pediatrics, CH Versailles, Le Chesnay, France
| | | | - Philippe Bidet
- Department of General Pediatrics, CHU Robert Debré, Paris and University Paris Diderot, Sorbonne Paris Cité, Paris, France Department of Microbiology, CHU Robert Debré, Paris, France
| | - Corinne Alberti
- INSERM, U 1123, ECEVE, CIC-EC 1426 Hôpital Robert Debré, Paris, France
| | - Robert Cohen
- ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France Unité Court Séjour, Petits Nourrissons, Service de Néonatologie, et Centre de Recherche Clinique, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Albert Faye
- INSERM, U 1123, ECEVE, CIC-EC 1426 Hôpital Robert Debré, Paris, France Department of General Pediatrics, CHU Robert Debré, Paris and University Paris Diderot, Sorbonne Paris Cité, Paris, France ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France
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15
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Golińska E, van der Linden M, Więcek G, Mikołajczyk D, Machul A, Samet A, Piórkowska A, Dorycka M, Heczko PB, Strus M. Virulence factors of Streptococcus pyogenes strains from women in peri-labor with invasive infections. Eur J Clin Microbiol Infect Dis 2016; 35:747-54. [PMID: 26873375 PMCID: PMC4840219 DOI: 10.1007/s10096-016-2593-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 01/19/2016] [Indexed: 10/24/2022]
Abstract
Invasive group A streptococcal (GAS) infections constitute an important epidemiological problem. Many cases occur in women during the postnatal period. The objective of this study was to evaluate the presence of the genes responsible for production of iron-chelating protein (perR) and superantigens (speA, speB, speC, speF, speG, speH, speI, speJ, speK, speL, speM, smeZ, and ssa) in S. pyogenes strains isolated from invasive infections in women after delivery. Furthermore, this study sought to verify whether S. pyogenes strains show special phenotypic and genotypic (sla, spy1325) characteristics that may play a decisive role in adherence to the genital tract epithelium. Moreover, the emm-types and antibiotic susceptibility were determined. We tested 30 invasive S. pyogenes strains isolated from postpartum invasive infection and 37 GAS control strains isolated from the genital tracts of asymptomatic multiparous women. The majority of the tested strains were shown to express two types of emm genes (1 and 28), though emm -12, -28, -75 and -89 were uniquely expressed in the group of strains isolated from invasive infections. A significantly higher prevalence of perR in the strains from puerperal fever was shown. Significant differences were also found between the two groups with respect to the incidence of the genes related to adherence; GAS strains originating from women with sepsis/puerperal fever showed presence of these genes less frequently than those of the control group. Although differences in frequencies of the gene coding for various superantigens were noted between the compared groups of GAS strains, they were not significant.
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Affiliation(s)
- E Golińska
- Jagiellonian University Medical College, 18 Czysta Str., 31-121, Kracow, Poland
| | - M van der Linden
- Institute of Microbiology, RWTH Aachen University, Faculty of Medicine and University Hospital, Aachen, Germany
| | - G Więcek
- Jagiellonian University Medical College, 18 Czysta Str., 31-121, Kracow, Poland
| | - D Mikołajczyk
- Jagiellonian University Medical College, 18 Czysta Str., 31-121, Kracow, Poland
| | - A Machul
- Jagiellonian University Medical College, 18 Czysta Str., 31-121, Kracow, Poland
| | - A Samet
- Department of Clinical Microbiology, University Clinical Center in Gdansk, 7 Debinki Str., 80-952, Gdansk, Poland
| | - A Piórkowska
- Department of Clinical Microbiology, University Clinical Center in Gdansk, 7 Debinki Str., 80-952, Gdansk, Poland
| | - M Dorycka
- Microbiological Laboratory, Diagnostics Inc., Kracow Branch, Na Skarpie 66 axis, 31-913, Kracow, Poland
| | - P B Heczko
- Jagiellonian University Medical College, 18 Czysta Str., 31-121, Kracow, Poland
| | - M Strus
- Jagiellonian University Medical College, 18 Czysta Str., 31-121, Kracow, Poland.
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16
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Reassessment of the Role of Rapid Antigen Detection Tests in Diagnosis of Invasive Group A Streptococcal Infections. J Clin Microbiol 2016; 54:994-9. [PMID: 26818671 DOI: 10.1128/jcm.02516-15] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 01/20/2016] [Indexed: 02/03/2023] Open
Abstract
Rapid antigen detection tests (RADTs) for group A streptococci (GAS) are widely used for diagnosing acute pharyngitis, which has led to a considerable reduction in antibiotic prescriptions over the past decade. Beyond this intended use, their reassessment on invasive samples may be relevant in the management of life-threatening GAS infections. To this end, we evaluated the performances of three RADTs, culture, GAS PCR, and 16S rRNA gene PCR assays, and compared them with a composite gold standard (GAS-PCR assay and/or culture) for the diagnosis of severe GAS infection. A total of 192 specimens from deep-tissue (mostly normally sterile) sites enriched for 75 GAS-positive samples were enrolled in the study. The three evaluated RADTs showed sensitivities ranging from 88.0% to 94.7% versus 98.7% for GAS PCR, 84% for 16S rRNA gene PCR, and 77.3% for culture. The sensitivities of the ImmunoCardSTAT! Strep A test (Meridian Bioscience) and the NADAL Strep A strip (Nal Von Minden) were similar to that of GAS PCR (P= 0.25 and 0.03, respectively) and higher than that of culture (P= 0.001 and 0.006, respectively), whereas the SD Bioline Strep A test strip (Standard Diagnostics) showed a performance similar to that of culture (P= 0.02). The three RADTs detected 10 distinctemmtypes, including a predominance ofemm1 (33.3%),emm89 (10.6%), andemm12 (7.6%). No false-positive results were observed, leading to a specificity of 100% for all the evaluated RADTs. The GAS RADTs turned out to be sensitive, specific, and easy-to-use tools that may aid in the management of invasive GAS infections in 24/7 point-of-care laboratories by enabling early diagnosis and focused therapy.
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17
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Imöhl M, van der Linden M. Antimicrobial Susceptibility of Invasive Streptococcus pyogenes Isolates in Germany during 2003-2013. PLoS One 2015; 10:e0137313. [PMID: 26340445 PMCID: PMC4560406 DOI: 10.1371/journal.pone.0137313] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 08/14/2015] [Indexed: 11/19/2022] Open
Abstract
A nationwide laboratory-based surveillance study of invasive S. pyogenes infections was conducted in Germany. Invasive isolates (n = 1,281) were obtained between 2003 and 2013. All isolates were susceptible to penicillin, cefotaxime and vancomycin. Tetracycline showed the highest rate of resistant or intermediate resistant isolates with 9.8%, followed by macrolides (4.0%), trimethoprim/sulfamethoxazole (SXT) (1.9%), levofloxacin (1.3%), chloramphenicol (0.9%) and clindamycin (0.7%). The most prominent trends were the appearance of levofloxacin non-susceptible isolates since 2011, and an increase of SXT non-susceptibility since 2012.
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Affiliation(s)
- Matthias Imöhl
- Institute of Medical Microbiology and National Reference Center for Streptococci, University Hospital RWTH Aachen, Aachen, Germany
- * E-mail:
| | - Mark van der Linden
- Institute of Medical Microbiology and National Reference Center for Streptococci, University Hospital RWTH Aachen, Aachen, Germany
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18
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Abstract
BACKGROUND Group A streptococci (GAS) and other β-hemolytic streptococci (BHS) cause pharyngitis, severe invasive disease and serious nonsuppurative sequelae including rheumatic heart disease and post streptococcal glomerulonephritis. The aim of this study was to assess carriage rates and anti-streptococcal C5a peptidase (anti-SCP) IgG levels and identify epidemiologic factors related to carriage or seropositivity in Australian children. METHODS A throat swab and blood sample were collected for microbiological and serological analysis (anti-SCP IgG) in 542 healthy children aged 0-10 years. Sequence analysis of the SCP gene was performed. Serological analysis used a competitive Luminex Immunoassay designed to preferentially detect functional antibody. RESULTS GAS-positive culture prevalence in throat swabs was 5.0% (range 0-10%), with the highest rate in 5 and 9 years old children. The rate of non-GAS BHS carriage was low (<1%). The scp gene was present in all 22 isolates evaluated. As age of child increased, the rate of carriage increased; odds ratio, 1.14 (1.00, 1.29); P = 0.50. Geometric mean anti-SCP titers increased with each age-band from 2 to 7 years, then plateaued. Age, geographic location and number of children within the household were significantly associated with the presence of anti-SCP antibodies. CONCLUSIONS Children are exposed to GAS and other BHS at a young age, which is important for determining the target age for vaccination to protect before the period of risk.
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Malota M, Felbinger TW, Ruppert R, Nüssler NC. Group A Streptococci: A rare and often misdiagnosed cause of spontaneous bacterial peritonitis in adults. Int J Surg Case Rep 2014; 6C:251-5. [PMID: 25555146 PMCID: PMC4347958 DOI: 10.1016/j.ijscr.2014.10.060] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 10/15/2014] [Indexed: 11/15/2022] Open
Abstract
We present three different and well-described cases of severe GAS peritonitis. We give a review of current literature. We highlight the difficulties in treatment and diagnostics.
Introduction Acute primary peritonitis due to group A Streptococci (GAS) is a rare but life-threatening infection. Unlike other forms of primary peritonitis it affects predominantly young previously healthy individuals and thus is often confused with the more frequent secondary peritonitis. A case series of three patients is presented as well as a review of the literature focusing on pitfalls in the diagnose and therapy of GAS peritonitis. Methods A retrospective analysis of three patients with primary GAS peritonitis was performed. Furthermore a systematic review of all cases of primary GAS peritonitis published from 1990 to 2013 was performed comparing demographics and clinical presentation, as well as radiological imaging, treatment and outcome. Results All three female patients presented initially with high fever, nausea and severe abdominal pain. Radiological imaging revealed intraperitoneal fluid collections of various degrees, but no underlying cause of peritonitis. Broad antibiotic treatment was started and surgical exploration was performed for acute abdomen in all three cases. Intraoperatively fibrinous peritonitis was observed, but the correct diagnosis was not made until microbiological analysis confirmed GAS peritonitis. One patient died within 24 h after admission. The other two patients recovered after multiple surgeries and several weeks on the intensive care unit due to multiple organ dysfunction syndrome. The fulminant clinical course of the three patients resembled those of many of the published cases: flu-like symptoms, high fever, severe acute abdominal pain and fibrinous peritonitis without obvious infectious focus were the most common symptoms reported in the literature. Conclusion GAS primary peritonitis should be considered in particular in young, previously healthy women who present with peritonitis but lack radiological findings of an infectious focus. The treatment of choice is immediate antibiotic therapy. Surgical intervention is difficult to avoid, since the diagnosis of GAS peritonitis is usually not confirmed until other causes of secondary peritonitis have been excluded.
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Affiliation(s)
- Mark Malota
- Department of General and Visceral Surgery, Endocrine Surgery and Coloproctology, Klinikum Neuperlach, Städtisches Klinikum München GmbH, Munich, Germany.
| | - Thomas W Felbinger
- Department of Anesthesiology, Critical Care and Pain Medicine, Klinikum Neuperlach, Städtisches Klinikum München GmbH, Munich, Germany
| | - Reinhard Ruppert
- Department of General and Visceral Surgery, Endocrine Surgery and Coloproctology, Klinikum Neuperlach, Städtisches Klinikum München GmbH, Munich, Germany
| | - Natascha C Nüssler
- Department of General and Visceral Surgery, Endocrine Surgery and Coloproctology, Klinikum Neuperlach, Städtisches Klinikum München GmbH, Munich, Germany
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Middleton B, Morris P, Carapetis J. Invasive group A streptococcal infection in the Northern Territory, Australia: case report and review of the literature. J Paediatr Child Health 2014; 50:869-73. [PMID: 24957474 DOI: 10.1111/jpc.12659] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2014] [Indexed: 11/30/2022]
Abstract
The increasing incidence of invasive group A streptococcus has been well documented in the temperate climates of North America, Europe and the United Kingdom. Studies also suggest that there are high rates of invasive group A streptococcus infection within the indigenous population of Northern Australia. This review article presents the case of infant Aboriginal twins with invasive group A streptococcal infection complicated by streptococcal toxic shock syndrome, highlighting both the severity and high transmissibility of invasive group A streptococcal disease. We review the epidemiology of group A streptococcal infection and suggest a potential role for chemoprophylaxis of household contacts to reduce the burden of disease within the indigenous population of Northern Australia.
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Santagati M, Spanu T, Scillato M, Santangelo R, Cavallaro F, Arena V, Castiglione G, Falcone M, Venditti M, Stefani S. Rapidly fatal hemorrhagic pneumonia and group A Streptococcus serotype M1. Emerg Infect Dis 2014; 20:98-101. [PMID: 24520561 PMCID: PMC3884710 DOI: 10.3201/eid2001.130233] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We report 3 cases of fulminant hemorrhagic pneumonia in previously health patients. Sudden-onset hemoptysis and dyspnea developed; all 3 patients and died <12 h later of massive pulmonary bleeding, despite aggressive supportive care. Postmortem analysis showed that the illnesses were caused by group A Streptococcusemm1/sequence type 28 strains.
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Westwood DA, Roberts RH. Management of Primary Group A Streptococcal Peritonitis: A Systematic Review. Surg Infect (Larchmt) 2013; 14:171-6. [DOI: 10.1089/sur.2012.038] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- David A. Westwood
- Department of Surgery, Christchurch Hospital, Canterbury, New Zealand
| | - Ross H. Roberts
- Department of Surgery, Christchurch Hospital, Canterbury, New Zealand
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Kotloff KL. Streptococcus group A vaccines. Vaccines (Basel) 2013. [DOI: 10.1016/b978-1-4557-0090-5.00061-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Steer AC, Lamagni T, Curtis N, Carapetis JR. Invasive group a streptococcal disease: epidemiology, pathogenesis and management. Drugs 2012; 72:1213-27. [PMID: 22686614 PMCID: PMC7100837 DOI: 10.2165/11634180-000000000-00000] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Invasive group A streptococcal infections are uncommon, although serious, infections with high case fatality rates. Periodic resurgences in invasive group A streptococcal infections in industrialized countries have been reported from the 1980s onwards, with current estimates of incidence in these countries of approximately 3–4 per 100000 population. Infants, pregnant women and the elderly are at increased risk of invasive group A streptococcal infection. The group A streptococcus has an array of virulence factors that underpin its invasive capacity and, in approximately 10% of cases, super-antigen toxins produced by the bacteria stimulate a large proportion of T cells, leading to streptococcal toxic shock syndrome. Given the rapid clinical progression, effective management of invasive group A streptococcal infections hinges on early recognition of the disease and prompt initiation of supportive care (often intensive care) together with antibacterial therapy. In cases of toxic shock syndrome, it is often difficult to distinguish between streptococcal and staphylococcal infection before cultures become available and so antibacterial choice must include coverage of both of these organisms. In addition, clindamycin is an important adjunctive antibacterial because of its anti-toxin effects and excellent tissue penetration. Early institution of intravenous immunoglobulin therapy should be considered in cases of toxic shock syndrome and severe invasive infection, including necrotizing fasciitis. Early surgical debridement of necrotic tissue is also an important part of management in cases of necrotizing fasciitis.
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Affiliation(s)
- Andrew C Steer
- Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.
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Wong SS, Yuen KY. Streptococcus pyogenes and re-emergence of scarlet fever as a public health problem. Emerg Microbes Infect 2012; 1:e2. [PMID: 26038416 PMCID: PMC3630912 DOI: 10.1038/emi.2012.9] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 04/16/2012] [Indexed: 11/09/2022]
Abstract
Explosive outbreaks of infectious diseases occasionally occur without immediately obvious epidemiological or microbiological explanations. Plague, cholera and Streptococcus pyogenes infection are some of the epidemic-prone bacterial infections. Besides epidemiological and conventional microbiological methods, the next-generation gene sequencing technology permits prompt detection of genomic and transcriptomic profiles associated with invasive phenotypes. Horizontal gene transfer due to mobile genetic elements carrying virulence factors and antimicrobial resistance, or mutations associated with the two component CovRS operon are important bacterial factors conferring survival advantage or invasiveness. The high incidence of scarlet fever in children less than 10 years old suggests that the lack of protective immunity is an important host factor. A high population density, overcrowded living environment and a low yearly rainfall are environmental factors contributing to outbreak development. Inappropriate antibiotic use is not only ineffective for treatment, but may actually drive an epidemic caused by drug-resistant strains and worsen patient outcomes by increasing the bacterial density at the site of infection and inducing toxin production. Surveillance of severe S. pyogenes infection is important because it can complicate concurrent chickenpox and influenza. Concomitant outbreaks of these two latter infections with a highly virulent and drug-resistant S. pyogenes strain can be disastrous.
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Affiliation(s)
- Samson Sy Wong
- Department of Microbiology, Research Centre for Infection and Immunology, Faculty of Medicine, The University of Hong Kong , Hong Kong, China
| | - Kwok-Yung Yuen
- Department of Microbiology, Research Centre for Infection and Immunology, Faculty of Medicine, The University of Hong Kong , Hong Kong, China
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26
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Stockmann C, Ampofo K, Hersh AL, Blaschke AJ, Kendall BA, Korgenski K, Daly J, Hill HR, Byington CL, Pavia AT. Evolving epidemiologic characteristics of invasive group a streptococcal disease in Utah, 2002-2010. Clin Infect Dis 2012; 55:479-87. [PMID: 22534148 DOI: 10.1093/cid/cis422] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Invasive group A Streptococcus (GAS) infections are associated with substantial morbidity and mortality. Recent national surveillance data report stable rates of invasive GAS disease, although these may not capture geographic variation. METHODS We performed a population-based, retrospective laboratory surveillance study of invasive GAS disease among Utah residents from 2002-2010. We used Intermountain Healthcare's electronic medical records and data warehouse to identify patients from whom GAS was isolated by culture. We defined clinical syndromes of invasive GAS disease on the basis of International Classification of Diseases, Ninth Revision codes. We abstracted demographic information, comorbidities, and microbiologic and laboratory findings. RESULTS From 2002-2010, we identified 1514 cases of invasive GAS disease among Utah residents. The estimated mean annual incidence rate was 6.3 cases/100,000 persons, which was higher than the national rate of 3.6 cases/100,000 (P < .01). The incidence of invasive GAS disease in Utah rose from 3.5 cases/100,000 persons in 2002 to 9.8 cases/100,000 persons in 2010 (P = .01). Among children aged <18 years, the incidence of invasive GAS increased from 3.0 cases/100,000 children in 2002 to 14.1 cases/100,000 children in 2010 (P < .01). The increase in the pediatric population was due, in part, to an increase in GAS pneumonia (P = .047). The rate of invasive GAS disease in adults aged 18-64 years increased from 3.4 cases/100 000 persons in 2002 to 7.6 cases/100,000 persons in 2010 (P = .02). Rates among those aged ≥65 years were stable. The incidence of acute rheumatic fever declined from 6.1 to 3.7 cases/100,000 (P = .04). CONCLUSIONS The epidemiologic characteristics of invasive GAS disease in Utah has changed substantially over the past decade, including a significant increase in the overall incidence of invasive disease-driven primarily by increasing disease in younger persons-that coincided temporally with a decrease in the incidence of acute rheumatic fever.
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Affiliation(s)
- Chris Stockmann
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Utah Health Sciences Center, Salt Lake City, 84108, USA.
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Acosta CD, Bhattacharya S, Tuffnell D, Kurinczuk JJ, Knight M. Maternal sepsis: a Scottish population-based case-control study. BJOG 2012; 119:474-83. [PMID: 22251396 PMCID: PMC3328752 DOI: 10.1111/j.1471-0528.2011.03239.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To describe the risk of maternal sepsis associated with obesity and other understudied risk factors such as operative vaginal delivery. DESIGN Population-based, case-control study. SETTING North NHS region of Scotland. POPULATION All cases of pregnant, intrapartum and postpartum women with International Classification of Disease-9 codes for sepsis or severe sepsis recorded in the Aberdeen Maternal and Neonatal Databank (AMND) from 1986 to 2009. Four controls per case selected from the AMND were frequency matched on year-of-delivery. METHODS Cases and controls were compared; significant variables from univariable regression were adjusted in a multivariable logistic regression model. MAIN OUTCOME MEASURES Dependent variables were uncomplicated sepsis or severe ('near-miss') sepsis. Independent variables were demographic, medical and clinical delivery characteristics. Unadjusted and adjusted odds ratios (OR) with 95% confidence intervals (95% CI) are reported. RESULTS Controlling for mode of delivery and demographic and clinical factors, obese women had twice the odds of uncomplicated sepsis (OR 2.12; 95% CI 1.14-3.89) compared with women of normal weight. Age <25 years (OR 5.15; 95% CI 2.43-10.90) and operative vaginal delivery (OR 2.20; 95% CI 1.02-4.87) were also significant predictors of sepsis. Known risk factors for maternal sepsis were also significant in this study (OR for uncomplicated and severe sepsis respectively): multiparity (OR 6.29, 12.04), anaemia (OR 3.43, 18.49), labour induction (OR 3.92 severe only), caesarean section (OR 3.23, 13.35), and preterm birth (OR 2.46 uncomplicated only). CONCLUSIONS Obesity, operative vaginal delivery and age <25 years are significant risk factors for sepsis and should be considered in clinical obstetric care.
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Affiliation(s)
- C D Acosta
- National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK.
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Abstract
Group A streptococcus (GAS) or Streptococcus pyogenes has been recognised as an important human pathogen since early days of modern microbiology, and it remains among the top ten causes of mortality from an infectious disease. Clinical manifestations attributable to this organism are perhaps the most diverse of any single human pathogen. These encompass invasive GAS infections, with high mortality rates despite effective antimicrobials, toxin-mediated diseases including scarlet fever and streptococcal toxic shock syndrome, the autoimmune sequelae of rheumatic fever and glomerulonephritis with potential for long-term disability, and nuisance manifestations of superficial skin and pharyngeal infection, which continue to consume a sizable proportion of healthcare resources. Although an historical perspective indicates major overall reductions in GAS infection rates in the modern era, chiefly as a result of widespread improvements in socioeconomic circumstances, this pathogen remains as a leading infectious cause of global morbidity and mortality. More than 18 million people globally are estimated to suffer from serious GAS disease. This burden disproportionally affects least affluent populations, and is a major cause of illness and death among children and young adults, including pregnant women, in low-resource settings. We review GAS transmission characteristics and prevention strategies, historical and geographical trends and report on the estimated global burden disease attributable to GAS. The lack of systematic reporting makes accurate estimation of rates difficult. This highlights the need to support improved surveillance and epidemiological research in low-resource settings, in order to enable better assessment of national and global disease burdens, target control strategies appropriately and assess the success of control interventions.
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Control measures for invasive group A streptococci (iGAS) outbreaks in care homes. J Infect 2011; 64:156-61. [PMID: 22138601 DOI: 10.1016/j.jinf.2011.11.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 11/15/2011] [Accepted: 11/17/2011] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The incidence of invasive group A streptococcal infections (iGAS) is increasing in Europe, with a particularly high morbidity and mortality in the elderly. Control of outbreaks in care homes is therefore important; but is unclear how best to manage these incidents. We attempted to identify which control measures are most likely to be effective. METHODS We undertook literature searches using PubMed and Google Scholar and contacted colleagues in Health Protection Units in England for unpublished outbreaks. RESULTS We identified 31 outbreaks; of which 20 had sufficient detail for further analysis. Overall carriage rates of GAS in care home residents identified in outbreak investigations were 4.7%, and in staff 3.2%. In 8 outbreaks mass antibiotic prophylaxis was offered, in 9 selective prophylaxis only and in 3 none at all. Surveillance swabbing had limited influence on decisions regarding prophylaxis. A few papers mentioned the role of environmental contamination and the risk from an affected roommate. CONCLUSIONS Pooling of results from these outbreaks failed to suggest any clear advantage to either a selective or mass antibiotic prophylaxis strategy in controlling spread. Systematic investigation and data collection from future outbreaks could be of benefit in informing future policy.
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[Guidelines for the management of sore throat from the German Society of General Practice and Family Medicine]. HNO 2011; 59:480-4. [PMID: 21424132 DOI: 10.1007/s00106-011-2263-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM The aim of this guideline is to propose a diagnostic and therapeutic approach to manage sore throat in ambulatory care. METHOD Relevant literature on the treatment of sore throat in primary care was retrieved and evaluated. During its development, the guidelines underwent a panel test, a practice test and a consensus conference. RECOMMENDATIONS Sore throat is mostly a short, self-limiting infection. Accurate etiologic diagnosis is generally not possible. Routine antibiotic treatment of sore throat for the prevention of complications is currently not indicated. The effect of antibiotics on symptoms and duration of disease is, at best, moderate. It is more pronounced in patients with typical clinical symptoms and signs of pharyngitis caused by group A streptococci (GAS) and slightly more pronounced again in cases of additional positive throat swab for GAS. An algorithm for decision-making is proposed. Rapid testing for streptococcal antigen or a culture for GAS is only recommended if the result is likely to influence therapeutic decision-making. Patients with more severe illness and signs of GAS pharyngitis can be given antibiotic therapy for symptomatic relief.
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Imöhl M, van der Linden M, Reinert RR, Ritter K. Invasive group A streptococcal disease and association with varicella in Germany, 1996–2009. ACTA ACUST UNITED AC 2011; 62:101-9. [DOI: 10.1111/j.1574-695x.2011.00788.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Llagunes J, Casanova I, Reina C, Carmona P, Pirola A, de Andrés J. [Late-onset postpartum sepsis with septic shock and heart dysfunction]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2011; 58:387-389. [PMID: 21797090 DOI: 10.1016/s0034-9356(11)70089-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We report a case of late-onset postpartum sepsis from endometritis due to group A streptococci (GAS) in a 37-year-old white woman. The patient developed septic shock, with mitral regurgitation and cardiac dysfunction. Early treatment with broad-spectrum antibiotics and hemodynamic support was essential for a favorable outcome. Because of the resurgence of virulent strains of GAS that can cause fatal infections, these pathogens should be included in the differential diagnosis of postpartum infections in the mother. Although cardiac dysfunction is rare in association with GAS infection, it should be ruled out by echocardiography when the condition of a patient with sepsis does not improve.
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Affiliation(s)
- J Llagunes
- Servicio de Anestesiologia, Cuidados Críticos y Medicina del Dolor, Consorcio Hospital General Universitario, Valencia
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Bidet P, Plainvert C, Doit C, Mariani-Kurkdjian P, Bonacorsi S, Lepoutre A, Bouvet A, Poyart C, Bingen E. Infections à Streptococcus pyogenes ou streptocoque du groupe A chez l’enfant : données du Centre national de référence (CNR). Arch Pediatr 2010; 17:201-8. [DOI: 10.1016/j.arcped.2009.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Revised: 09/22/2009] [Accepted: 10/12/2009] [Indexed: 11/25/2022]
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A 7-year-old boy with acute onset of breathing difficulty. Pediatr Emerg Care 2010; 26:149-51. [PMID: 20145509 DOI: 10.1097/pec.0b013e3181d0a04e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Group A streptococcus (GAS) is a major bacterial pathogen affecting children globally. Approximately 15% of school-age children experience a symptomatic episode of GAS culture-positive pharyngitis each year. Although the incidence of invasive GAS disease under these circumstances is low (0.5%-2%), an increasing number of invasive GAS cases have been reported over the last 2 decades. This report describes a 7-year-old boy who, after being treated for GAS pharyngitis, developed a fatal streptococcal toxic shock syndrome.
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Imöhl M, Reinert RR, Ocklenburg C, van der Linden M. Epidemiology of invasive Streptococcus pyogenes disease in Germany during 2003-2007. ACTA ACUST UNITED AC 2010; 58:389-96. [PMID: 20146737 DOI: 10.1111/j.1574-695x.2010.00652.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A nationwide laboratory-based surveillance study of invasive Streptococcus pyogenes infections was conducted in Germany. Invasive isolates (n=586) were obtained between 2003 and 2007. Most isolates were obtained from blood (53.9%) or skin lesions (17.6%). The most common emm types were emm 1 (30.5%), emm 28 (18.3%) and emm 3 (9.6%). Overall, speA was positive in 45.9%, speC in 44.7% and ssa in 14.8% of isolates. SpeA was common in emm type 1 (100%) and emm type 3 (96.4%), whereas speC was often observed in emm type 28 (93.5%). The most frequent clinical manifestations included sepsis (40.1%), necrotizing fasciitis (20.8%) and streptococcal toxic shock syndrome (16.6%). All isolates were susceptible to penicillin G, cefotaxime and levofloxacin. Tetracycline shows the highest rate of resistant or intermediate isolates with 11.6%, followed by clarithromycin (5.5%) and clindamycin (1.2%). The most prominent trend is the reduction of tetracycline-nonsusceptible isolates from 18.6% in 2003 to 8.9% in 2007.
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Affiliation(s)
- Matthias Imöhl
- National Reference Center for Streptococci, Institute of Medical Microbiology, University Hospital, Aachen, Germany
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36
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Henriet S, Kaguelidou F, Bidet P, Lorrot M, Lauzanne A, Dauger S, Angoulvant F, Mercier JC, Alberti C, Bingen E, Faye A. Invasive group A streptococcal infection in children: clinical manifestations and molecular characterization in a French pediatric tertiary care center. Eur J Clin Microbiol Infect Dis 2010; 29:341-6. [DOI: 10.1007/s10096-009-0854-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2009] [Accepted: 12/05/2009] [Indexed: 11/28/2022]
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Steer AC, Law I, Matatolu L, Beall BW, Carapetis JR. Global emm type distribution of group A streptococci: systematic review and implications for vaccine development. THE LANCET. INFECTIOUS DISEASES 2009; 9:611-6. [PMID: 19778763 DOI: 10.1016/s1473-3099(09)70178-1] [Citation(s) in RCA: 377] [Impact Index Per Article: 25.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
emm sequence typing is the most widely used method for defining group A streptococcal (GAS) strains, and has been applied to isolates in all regions of the world. We did a systematic review of the global distribution of GAS emm types. 102 articles and reports were included (38 081 isolates). Epidemiological data from high-income countries were predominant, with sparse data from low-income countries. The epidemiology of GAS disease in Africa and the Pacific region seems to be different from that in other regions, particularly high-income countries. In Africa and the Pacific, there were no dominant emm types, a higher diversity of emm types, and many of the common emm types in other parts of the world were less common (including emm 1, 4, 6, and 12). Our data have implications for the development of GAS vaccines. On the basis of the available data, the current formulation of the experimental multivalent emm vaccine would provide good coverage in high-income countries, particularly USA, Canada, and Europe, but poor coverage in Africa and the Pacific, and only average coverage in Asia and the Middle East.
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Affiliation(s)
- Andrew C Steer
- Centre for International Child Health, University of Melbourne, Australia.
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38
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Molecular characteristics of pharyngeal and invasive emm3 Streptococcus pyogenes strains from Norway, 1988–2003. Eur J Clin Microbiol Infect Dis 2009; 29:31-43. [DOI: 10.1007/s10096-009-0814-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2009] [Accepted: 09/02/2009] [Indexed: 10/20/2022]
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39
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Novel strategies for controlling
Streptococcus pyogenes
infection and associated diseases: from potential peptide vaccines to antibody immunotherapy. Immunol Cell Biol 2009; 87:391-9. [DOI: 10.1038/icb.2009.29] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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40
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Steer AC, Jenney A, Kado J, Good MF, Batzloff M, Waqatakirewa L, Mullholland EK, Carapetis JR. Prospective Surveillance of Invasive Group A Streptococcal Disease, Fiji, 2005–2007. Emerg Infect Dis 2009. [DOI: 10.3201/eid15/2.080558] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Rantala S, Vuopio-Varkila J, Vuento R, Huhtala H, Syrjänen J. Clinical presentations and epidemiology of beta-haemolytic streptococcal bacteraemia: a population-based study. Clin Microbiol Infect 2009; 15:286-8. [PMID: 19175622 DOI: 10.1111/j.1469-0691.2008.02672.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In this population-based study, all 314 episodes of beta-haemolytic streptococcal bacteraemia in adult patients in the Pirkanmaa area, Finland, during the 10-year period 1995-2004 were retrospectively reviewed. Altogether, 92 cases of bacteraemia caused by Lancefield group A beta-haemolytic streptococci (GAS), 76 caused by group B beta-haemolytic streptococci (GBS), 18 caused by group C beta-haemolytic streptococci (GCS) and 128 caused by group G beta-haemolytic streptococci (GGS) were identified. The most important finding was that the incidence of GGS increased during the study period. Disruption of the cutaneous barrier was a very common predisposing factor in GAS and GGS bacteraemias. Skin infections were the presenting clinical manifestations in two-thirds of GAS and GGS bacteraemias.
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Affiliation(s)
- S Rantala
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.
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42
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Lamagni TL, Neal S, Keshishian C, Hope V, George R, Duckworth G, Vuopio-Varkila J, Efstratiou A. Epidemic of severe Streptococcus pyogenes infections in injecting drug users in the UK, 2003-2004. Clin Microbiol Infect 2009; 14:1002-9. [PMID: 19040471 DOI: 10.1111/j.1469-0691.2008.02076.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
During the late 1990s, increases in referrals to the national reference laboratory of Streptococcus pyogenes isolates from injecting drug users (IDUs) with severe soft tissue infection indicated an emerging problem in the UK, later confirmed during the 2003-2004 European enhanced surveillance (Strep-EURO) programme. In light of these findings, further analyses were undertaken in an attempt to understand the reasons behind this increase in referrals. Single and multivariable analyses were undertaken to compare clinical, microbiological and demographic characteristics of IDUs diagnosed with severe S. pyogenes infection during the 2003-2004 enhanced surveillance study with those of other cases arising during this same period. Temporal and spatial analyses were undertaken for IDUs to identify clustering, as a means of understanding the transmission dynamics underpinning this increase. Infections in IDUs were spread across the UK, with some concentration in northern England and London. IDUs presented with a wide range of clinical manifestations, including pneumonia, which was found to be significantly more common in IDUs (OR 3.00) than in other cases. Marked differences in type distributions were found between IDUs and other cases, in particular the concentration of emm/M83 (22% of IDUs, 2% of non-IDUs). These findings indicate that an epidemic of severe S. pyogenes infections in IDUs occurred in the UK, peaking in 2003. The explanation for this rise remains unclear.
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Affiliation(s)
- T L Lamagni
- Health Protection Agency Centre for Infections, London, UK.
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43
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Streptococcal Infections. BACTERIAL INFECTIONS OF HUMANS 2009. [PMCID: PMC7121349 DOI: 10.1007/978-0-387-09843-2_35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
The streptococci are a large heterogeneous group of gram-positive spherically shaped bacteria widely distributed in nature. They include some of the most important agents of human disease as well as members of the normal human flora. Some streptococci have been associated mainly with disease in animals, while others have been domesticated and used for the culture of buttermilk, yogurt, and certain cheeses. Those known to cause human disease comprise two broad categories: First are the pyogenic streptococci, including the familiar β-hemolytic streptococci and the pneumococcus. These organisms are not generally part of the normal flora but cause acute, often severe, infections in normal hosts. Second are the more diverse enteric and oral streptococci, which are nearly always part of the normal flora and which are more frequently associated with opportunistic infections.
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Faibis F, Sapir D, Luis D, Laigneau P, Lepoutre A, Pospisil F, Borgey F, Demachy MC, Botterel F. Severe Group A Streptococcus Infection after Thyroidectomy: Report of Three Cases and Review. Surg Infect (Larchmt) 2008; 9:529-31. [DOI: 10.1089/sur.2007.069] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Frederic Faibis
- Laboratoire de Microbiologie, Hôpital de Meaux, Meaux, France
| | - David Sapir
- Service de Réanimation Polyvalente, Hôpital de Meaux, Meaux, France
| | - David Luis
- Service de Réanimation Polyvalente, Hôpital de Meaux, Meaux, France
| | | | - Agnes Lepoutre
- Institut National de Veille Sanitaire, Saint-Maurice, France
| | | | - France Borgey
- Réseau Régional d'Hygiène de Basse-Normandie, Centre Hospitalier Universitaire Côte de Nacre, Caen, France
| | | | - Françoise Botterel
- Unité d'Hygiène et de Lutte Contre les Infections Nosocomiales, Hôpital de Meaux, and Service de Mycologie-Parasitologie, Centre Hospitalier Universitaire Henri Mondor, AP-HP, Créteil, France
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45
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Maripuu L, Eriksson A, Norgren M. Superantigen gene profile diversity among clinical group A streptococcal isolates. ACTA ACUST UNITED AC 2008; 54:236-44. [PMID: 18754783 DOI: 10.1111/j.1574-695x.2008.00469.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study examines the diversity of superantigen gene profiles between and within emm-genotypes of 92 clinical group A streptococcal isolates (30 STSS, 24 sepsis, 25 erysipelas, and 12 tonsillitis) collected in Sweden between 1986 and 2001. The emm-genotype and the distribution of smeZ, speG, speJ, speA, speC, speH, speI, speK/L, speL/M, speM, and ssa genes, and the smeZ allelic variant were determined using PCR and DNA sequencing. Forty-five emm1 isolates revealed 10 superantigen gene profiles. One profile dominated and was identified in 22 isolates collected over 14 years. The results indicate that a selective advantage maintained this genotype in circulation. The superantigen content among the emm1 isolates ranged from three to seven, with smeZ-1, speG, and speA present in all but one profile. The 47 isolates of 27 other emm-genotypes exhibited 29 superantigen gene profiles. Thus, the distribution of superantigen genes was highly variable within isolates regardless of emm-genotype. Two novel emm1 subtypes and 14 novel smeZ allelic variants were identified. The 22 smeZ alleles were generally linked to the emm-genotype. The results of the investigation show that superantigen gene profiling is useful for tracking spread of clones in the community.
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Affiliation(s)
- Linda Maripuu
- Biomedical Laboratory Science, Department of Clinical Microbiology, Umeå University, Umeå, Sweden.
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Miettinen M, Veckman V, Latvala S, Sareneva T, Matikainen S, Julkunen I. Live Lactobacillus rhamnosus and Streptococcus pyogenes differentially regulate Toll-like receptor (TLR) gene expression in human primary macrophages. J Leukoc Biol 2008; 84:1092-100. [PMID: 18625909 DOI: 10.1189/jlb.1206737] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Macrophages are phagocytes that recognize bacteria and subsequently activate appropriate innate and adaptive immune responses. TLRs are essential in identifying conserved bacterial structures and in initiating and mediating innate immune responses. In this work, we have characterized TLR gene expression in human monocyte-derived macrophages in response to stimulation with two live Gram-positive bacteria, a human commensal and probiotic Lactobacillus rhamnosus GG (LGG), and an important human pathogen Streptococcus pyogenes. LGG and S. pyogenes enhanced TLR2 expression in macrophages. LGG and S. pyogenes also required TLR2 for NF-kappaB activation. Only pathogenic S. pyogenes was able to up-regulate TLR3 and TLR7 gene expression. This up-regulation was dependent on IFN-alpha/beta, as neutralizing anti-IFN-alpha/beta antibodies reduced S. pyogenes-induced TLR3 and TLR7 mRNA expression. Our results show that despite similarities, TLR responses of macrophages differ for a Gram-positive probiotic and a pathogen. Our data suggest that macrophages can discriminate between probiotic and pathogenic bacteria by IFN-mediated TLR gene regulation.
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Affiliation(s)
- Minja Miettinen
- Department of Viral Diseases and Immunology, National Public Health Institute, Mannerheimintie 166, 00300 Helsinki, Finland.
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Abstract
BACKGROUND Most cases of invasive group A streptococcal (GAS) disease arise sporadically in the community, but outbreaks of severe invasive GAS infections have been reported in closed environments, such as military populations, family communities and hospitals. An outbreak of invasive GAS disease involving 3 cases of streptococcal toxic shock syndrome (TSS), one with a fatal course, occurred among children attending a day-care center located in Cantabria, Northern Spain. OBJECTIVE To determine the characteristics of GAS isolates obtained from the outbreak environment. METHODS GAS isolates obtained from children attending the same day-care facility, staff members, and family contacts were assayed for emm typing, pulse-field gel electrophoresis (PFGE), and toxin-gene content. One isolate obtained from the fatal case was also characterized by multilocus sequence typing. Antimicrobial susceptibility testing was done. Strains from patients unrelated to the outbreak were included for comparison. RESULTS All GAS isolates from children attending the day-care center, including those from streptococcal TSS cases, shared the same emm type 4, genomic pattern by PFGE (A) and toxin-gene profile. Neither the emm type nor the PFGE pattern or toxin gene profile of the outbreak-associated strains were encountered among GAS isolated from household or staff contacts. CONCLUSIONS A clone of GAS belonging to emm type 4 and characterized by a specific PFGE pattern and toxin-gene profile was responsible for a community outbreak of streptococcal TSS disease in a child day-care center in Spain. This is the first day-care outbreak reported in our country.
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Lamagni TL, Neal S, Keshishian C, Alhaddad N, George R, Duckworth G, Vuopio-Varkila J, Efstratiou A. Severe Streptococcus pyogenes infections, United Kingdom, 2003-2004. Emerg Infect Dis 2008; 14:202-9. [PMID: 18258111 PMCID: PMC2600190 DOI: 10.3201/eid1402.070888] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Epidemiology of severe disease caused by this organism has changed, with increased incidence and different risk groups. As part of a Europe-wide initiative to explore current epidemiologic patterns of severe disease caused by Streptococcus pyogenes, the United Kingdom undertook enhanced population-based surveillance during 2003–2004. A total of 3,775 confirmed cases of severe S. pyogenes infection were identified over 2 years, 3.33/100,000 population, substantially more than previously estimated. Skin/soft tissue infections were the most common manifestation (42%), followed by respiratory tract infections (17%). Injection drug use was identified as a risk factor for 20% of case-patients. One in 5 infected case-patients died within 7 days of diagnosis; the highest mortality rate was for cases of necrotizing fasciitis (34%). Nonsteroidal antiinflammatory drugs, alcoholism, young age, and infection with emm/M3 types were independently associated with increased risk for streptococcal toxic shock syndrome. Understanding the pattern of these diseases and predictors of poor patient outcome will help with identification and assessment of the potential effect of targeted interventions.
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Steer AC, Curtis N, Carapetis JR. Diagnosis and treatment of invasive group A streptococcal infections. ACTA ACUST UNITED AC 2008; 2:289-301. [DOI: 10.1517/17530059.2.3.289] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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50
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Kotloff KL. Streptococcus group A vaccines. Vaccines (Basel) 2008. [DOI: 10.1016/b978-1-4160-3611-1.50062-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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