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Cohen R, Cohen S, Afraimov M, Finn T, Babushkin F, Geller K, Paikin S, Yoffe I, Valinsky L, Ron M, Rokney A. Screening asymptomatic households for Streptococcus pyogenes pharyngeal carriage as a part of in-hospital investigation of puerperal sepsis. Am J Infect Control 2019; 47:1493-1499. [PMID: 31296346 DOI: 10.1016/j.ajic.2019.05.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/29/2019] [Accepted: 05/29/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Invasive group A streptococcal (iGAS) infection in the peripartum setting is a rare but devastating disease occasionally occurring as a health care-associated infection (HAI). Current guidelines suggest enhanced surveillance and streptococcal isolate storage after a single case of iGAS, as well as a full epidemiological investigation that includes screening health care workers (HCWs) from several sites after 2 cases. Current guidelines do not recommend routine screening of household members of a patient with iGAS. METHODS We conducted studies of 3 patients with iGAS puerperal sepsis and related epidemiologic and molecular investigations. RESULTS Identical GAS emm gene types were found in pharyngeal cultures of 3 asymptomatic spouses of patients with iGAS puerperal sepsis. HCWs screened negative for GAS, and emm typing indicated that other iGAS cases from this hospital were sporadic and not related to the puerperal cases. CONCLUSIONS The concurrent presence of the same emm type in a household member practically excludes the option of an inadvertent HAI or facility outbreak. Hence, we suggest that screening close family members for asymptomatic GAS carriage should be performed early as a part of infection prevention measures, as doing so would have significant utility in saving time and resources related to a full epidemiological inquiry.
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Affiliation(s)
- Regev Cohen
- Infectious Diseases Unit, Sanz Medical Center, Laniado Hospital, Netanya, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion Medicine, Haifa, Israel.
| | - Shoshana Cohen
- Infectious Diseases Unit, Sanz Medical Center, Laniado Hospital, Netanya, Israel
| | - Marina Afraimov
- Infectious Diseases Unit, Sanz Medical Center, Laniado Hospital, Netanya, Israel
| | - Talya Finn
- Infectious Diseases Unit, Sanz Medical Center, Laniado Hospital, Netanya, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion Medicine, Haifa, Israel
| | - Frida Babushkin
- Infectious Diseases Unit, Sanz Medical Center, Laniado Hospital, Netanya, Israel
| | - Keren Geller
- Infectious Diseases Unit, Sanz Medical Center, Laniado Hospital, Netanya, Israel
| | - Svetlana Paikin
- Microbiology Laboratory, Sanz Medical Center, Laniado Hospital, Netanya, Israel
| | - Irena Yoffe
- Hematology Ward, Sanz Medical Center, Laniado Hospital, Netanya, Israel
| | - Lea Valinsky
- Central Laboratories, Ministry of Health, Jerusalem, Israel
| | - Merav Ron
- Central Laboratories, Ministry of Health, Jerusalem, Israel
| | - Assaf Rokney
- Central Laboratories, Ministry of Health, Jerusalem, Israel
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Abstract
The development of a vaccine for group A streptococcus (GAS) is of paramount importance given that GAS infections cause more than 500,000 deaths annually across the world. This prospective passive surveillance laboratory study evaluated the potential coverage of the M protein-based vaccine currently under development. While a number of GAS strains isolated from this sub-Sahara African study were included in the current vaccine formulation, we nevertheless report that potential vaccine coverage for GAS infection in our setting was approximately 60%, with four of the most prevalent strains not included. This research emphasizes the need to reformulate the vaccine to improve coverage in areas where the burden of disease is high. Group A streptococcus (GAS) is responsible for a wide range of noninvasive group A streptococcal (non-iGAS) and invasive group A streptococcal (iGAS) infections. Information about the emm type variants of the M protein causing GAS disease is important to assess potential vaccine coverage of a 30-valent vaccine under development, particularly with respect to how they compare and contrast with non-iGAS isolates, especially in regions with a high burden of GAS. We conducted a prospective passive surveillance study of samples from patients attending public health facilities in Cape Town, South Africa. We documented demographic data and clinical presentation. emm typing was conducted using CDC protocols. GAS was commonly isolated from pus swabs, blood, deep tissue, and aspirates. Clinical presentations included wound infections (20%), bacteremia (15%), abscesses (9%), and septic arthritis (8%). Forty-six different emm types were identified, including M76 (16%), M81 (10%), M80 (6%), M43 (6%), and M183 (6%), and the emm types were almost evenly distributed between non-iGAS and iGAS isolates. There was a statistically significant association with M80 in patients presenting with noninvasive abscesses. Compared to the 30-valent vaccine under development, the levels of potential vaccine coverage for non-iGAS and iGAS infection were 60% and 58%, respectively, notably lower than the coverage in developed countries; five of the most prevalent emm types, M76, M81, M80, M43, and M183, were not included. The emm types from GAS isolated from patients with invasive disease did not differ significantly from those from noninvasive disease cases. There is low coverage of the multivalent M protein vaccine in our setting, emphasizing the need to reformulate the vaccine to improve coverage in areas where the burden of disease is high. IMPORTANCE The development of a vaccine for group A streptococcus (GAS) is of paramount importance given that GAS infections cause more than 500,000 deaths annually across the world. This prospective passive surveillance laboratory study evaluated the potential coverage of the M protein-based vaccine currently under development. While a number of GAS strains isolated from this sub-Sahara African study were included in the current vaccine formulation, we nevertheless report that potential vaccine coverage for GAS infection in our setting was approximately 60%, with four of the most prevalent strains not included. This research emphasizes the need to reformulate the vaccine to improve coverage in areas where the burden of disease is high.
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Laupland KB, Pasquill K, Parfitt EC, Steele L. Bloodstream infection due to β-hemolytic streptococci: a population-based comparative analysis. Infection 2019; 47:1021-1025. [PMID: 31515703 DOI: 10.1007/s15010-019-01356-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/04/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE Although the burden of illness due to Streptococcus pyogenes is widely recognized, other β-hemolytic streptococci are also important causes of invasive infections. The objective of this study was to compare the population-based epidemiology of groups A, B, and C/G β-hemolytic streptococcal bloodstream infection (BSI). METHODS Population-based surveillance was conducted in the western interior of British Columbia, Canada, 2011-2018. RESULTS A total of 210 episodes were identified for an incidence of 14.4 per 100,000; the incidences of groups A, B and C/G streptococcal BSI were 4.2, 4.7, and 5.5 per 100,000, respectively. There was an increasing annual incidence of β-hemolytic streptococcal BSI from 2011 through to a peak incidence in 2016 that decreased thereafter. Fifty-two percent (110) of BSIs were community associated, 43% (91) were healthcare associated, and 4% (9) were hospital onset. Patients with group A were younger, more likely to be female, and have fewer co-morbidities than patients with groups B and C/G streptococcal BSI. The most common focus of infection was soft tissue (109/52%), followed by primary (33; 16%), and bone and joint (20; 10%) and these varied by streptococcal species (p < 0.001). The 30-day all-cause case fatality rate was 11% (24/210) and did not significantly vary by group (p = 0.7). CONCLUSION Although the determinants vary, the overall burden of disease related to BSI is similar amongst groups A, B and C/G β-hemolytic streptococci.
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Affiliation(s)
- Kevin B Laupland
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Level 3 Ned Hanlon Building, Butterfield Street, Herston, QLD, 4029, Australia. .,Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia. .,Department of Medicine, Royal Inland Hospital, Kamloops, BC, Canada.
| | - Kelsey Pasquill
- Department of Pathology and Laboratory Medicine, Royal Inland Hospital, Kamloops, BC, Canada
| | | | - Lisa Steele
- Department of Pathology and Laboratory Medicine, Royal Inland Hospital, Kamloops, BC, Canada
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Adebanjo T, Apostol M, Alden N, Petit S, Tunali A, Torres S, Hollick R, Bell A, Muse A, Poissant T, Schaffner W, Van Beneden CA. Evaluating Household Transmission of Invasive Group A Streptococcus Disease in the United States Using Population-based Surveillance Data, 2013–2016. Clin Infect Dis 2019; 70:1478-1481. [DOI: 10.1093/cid/ciz716] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 07/26/2019] [Indexed: 02/05/2023] Open
Abstract
Abstract
Using population-based surveillance data, we quantified the secondary invasive group A Streptococcus disease risk among household contacts. The disease risk in the 30 days postexposure to an index-case patient was highest among individuals aged ≥65 years, versus the annual background incidence of all ages.
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Affiliation(s)
- Tolulope Adebanjo
- Epidemic Intelligence Service and Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Nisha Alden
- Colorado Emerging Infections Program, Denver
| | - Susan Petit
- Connecticut Department of Public Health, Hartford
| | - Amy Tunali
- Georgia Emerging Infections Program, Atlanta
| | | | - Rosemary Hollick
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | | | | | - Chris A Van Beneden
- Respiratory Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Abstract
Necrotizing soft-tissue infections are caused by a variety of bacterial pathogens that may affect patients at any age or health status. This orthopaedic emergency initially presents with nonspecific signs such as erythema and edema. As the disease progresses, classic signs such as bullae, cutaneous anesthesia, ecchymosis, tense edema, and gas can be seen. A high level of suspicion is needed to properly identify and treat in a timely manner. Pain out of proportion to presentation and rapid progression even with appropriate antibiotic treatment should heighten suspicion of a necrotizing soft-tissue infection. The mainstay of management is extensive débridement and decompression of all necrotic tissue and broad-spectrum antibiotics. Débridements are repeated to ensure that disease progression has been halted. Early surgical débridements should take precedent over transfer because of the high rate of limb loss and mortality as a result of surgical delay.
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56
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Hill HR. Fitness genes of group A streptococci in necrotizing fasciitis and myositis. J Clin Invest 2019; 129:516-517. [DOI: 10.1172/jci126482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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van Hensbergen VP, Movert E, de Maat V, Lüchtenborg C, Le Breton Y, Lambeau G, Payré C, Henningham A, Nizet V, van Strijp JAG, Brügger B, Carlsson F, McIver KS, van Sorge NM. Streptococcal Lancefield polysaccharides are critical cell wall determinants for human Group IIA secreted phospholipase A2 to exert its bactericidal effects. PLoS Pathog 2018; 14:e1007348. [PMID: 30321240 PMCID: PMC6201954 DOI: 10.1371/journal.ppat.1007348] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 10/25/2018] [Accepted: 09/20/2018] [Indexed: 12/21/2022] Open
Abstract
Human Group IIA secreted phospholipase A2 (hGIIA) is an acute phase protein with bactericidal activity against Gram-positive bacteria. Infection models in hGIIA transgenic mice have suggested the importance of hGIIA as an innate defense mechanism against the human pathogens Group A Streptococcus (GAS) and Group B Streptococcus (GBS). Compared to other Gram-positive bacteria, GAS is remarkably resistant to hGIIA activity. To identify GAS resistance mechanisms, we exposed a highly saturated GAS M1 transposon library to recombinant hGIIA and compared relative mutant abundance with library input through transposon-sequencing (Tn-seq). Based on transposon prevalence in the output library, we identified nine genes, including dltA and lytR, conferring increased hGIIA susceptibility. In addition, seven genes conferred increased hGIIA resistance, which included two genes, gacH and gacI that are located within the Group A Carbohydrate (GAC) gene cluster. Using GAS 5448 wild-type and the isogenic gacI mutant and gacI-complemented strains, we demonstrate that loss of the GAC N-acetylglucosamine (GlcNAc) side chain in the ΔgacI mutant increases hGIIA resistance approximately 10-fold, a phenotype that is conserved across different GAS serotypes. Increased resistance is associated with delayed penetration of hGIIA through the cell wall. Correspondingly, loss of the Lancefield Group B Carbohydrate (GBC) rendered GBS significantly more resistant to hGIIA-mediated killing. This suggests that the streptococcal Lancefield antigens, which are critical determinants for streptococcal physiology and virulence, are required for the bactericidal enzyme hGIIA to exert its bactericidal function.
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Affiliation(s)
- Vincent P. van Hensbergen
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Elin Movert
- Department of Experimental Medical Science, Section for Immunology, Lund University, Lund, Sweden
| | - Vincent de Maat
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Yoann Le Breton
- Department of Cell Biology & Molecular Genetics and Maryland Pathogen Research Institute, University of Maryland, College Park, MD, United States of America
| | - Gérard Lambeau
- Université Côte d'Azur, CNRS, Institut de Pharmacologie Moléculaire et Cellulaire, Department of Biochemistry, Valbonne, France
| | - Christine Payré
- Université Côte d'Azur, CNRS, Institut de Pharmacologie Moléculaire et Cellulaire, Department of Biochemistry, Valbonne, France
| | - Anna Henningham
- Department of Pediatrics and Skaggs School of Pharmacy & Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States of America
| | - Victor Nizet
- Department of Pediatrics and Skaggs School of Pharmacy & Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States of America
- Skaggs School of Pharmacy & Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA, United States of America
| | - Jos A. G. van Strijp
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Britta Brügger
- Heidelberg University, Biochemistry Center (BZH), Heidelberg, Germany
| | - Fredric Carlsson
- Department of Experimental Medical Science, Section for Immunology, Lund University, Lund, Sweden
- Department of Biology, Section for Molecular Cell Biology, Lund University, Lund, Sweden
| | - Kevin S. McIver
- Department of Cell Biology & Molecular Genetics and Maryland Pathogen Research Institute, University of Maryland, College Park, MD, United States of America
| | - Nina M. van Sorge
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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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: 43] [Impact Index Per Article: 7.2] [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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Dietary Cows' Milk Protein A1 Beta-Casein Increases the Incidence of T1D in NOD Mice. Nutrients 2018; 10:nu10091291. [PMID: 30213104 PMCID: PMC6163334 DOI: 10.3390/nu10091291] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 09/06/2018] [Accepted: 09/08/2018] [Indexed: 12/20/2022] Open
Abstract
The contribution of cows’ milk containing beta-casein protein A1 variant to the development of type 1 diabetes (T1D) has been controversial for decades. Despite epidemiological data demonstrating a relationship between A1 beta-casein consumption and T1D incidence, direct evidence is limited. We demonstrate that early life exposure to A1 beta-casein through the diet can modify progression to diabetes in non-obese diabetic (NOD) mice, with the effect apparent in later generations. Adult NOD mice from the F0 generation and all subsequent generations (F1 to F4) were fed either A1 or A2 beta-casein supplemented diets. Diabetes incidence in F0–F2 generations was similar in both cohorts of mice. However, diabetes incidence doubled in the F3 generation NOD mice fed an A1 beta-casein supplemented diet. In F4 NOD mice, subclinical insulitis and altered glucose handling was evident as early as 10 weeks of age in A1 fed mice only. A significant decrease in the proportion of non-conventional regulatory T cell subset defined as CD4+CD25−FoxP3+ was evident in the F4 generation of A1 fed mice. This feeding intervention study demonstrates that dietary A1 beta-casein may affect glucose homeostasis and T1D progression, although this effect takes generations to manifest.
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An Outbreak of Streptococcus pyogenes in a Mental Health Facility: Advantage of Well-Timed Whole-Genome Sequencing Over emm Typing. Infect Control Hosp Epidemiol 2018; 39:852-860. [PMID: 29739475 DOI: 10.1017/ice.2018.101] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEWe report the utility of whole-genome sequencing (WGS) conducted in a clinically relevant time frame (ie, sufficient for guiding management decision), in managing a Streptococcus pyogenes outbreak, and present a comparison of its performance with emm typing.SETTINGA 2,000-bed tertiary-care psychiatric hospital.METHODSActive surveillance was conducted to identify new cases of S. pyogenes. WGS guided targeted epidemiological investigations, and infection control measures were implemented. Single-nucleotide polymorphism (SNP)-based genome phylogeny, emm typing, and multilocus sequence typing (MLST) were performed. We compared the ability of WGS and emm typing to correctly identify person-to-person transmission and to guide the management of the outbreak.RESULTSThe study included 204 patients and 152 staff. We identified 35 patients and 2 staff members with S. pyogenes. WGS revealed polyclonal S. pyogenes infections with 3 genetically distinct phylogenetic clusters (C1-C3). Cluster C1 isolates were all emm type 4, sequence type 915 and had pairwise SNP differences of 0-5, which suggested recent person-to-person transmissions. Epidemiological investigation revealed that cluster C1 was mediated by dermal colonization and transmission of S. pyogenes in a male residential ward. Clusters C2 and C3 were genomically diverse, with pairwise SNP differences of 21-45 and 26-58, and emm 11 and mostly emm120, respectively. Clusters C2 and C3, which may have been considered person-to-person transmissions by emm typing, were shown by WGS to be unlikely by integrating pairwise SNP differences with epidemiology.CONCLUSIONSWGS had higher resolution than emm typing in identifying clusters with recent and ongoing person-to-person transmissions, which allowed implementation of targeted intervention to control the outbreak.Infect Control Hosp Epidemiol 2018;852-860.
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Hale AJ, Snyder GM, Ahern JW, Eliopoulos G, Ricotta D, Alston WK. When are Oral Antibiotics a Safe and Effective Choice for Bacterial Bloodstream Infections? An Evidence-Based Narrative Review. J Hosp Med 2018; 13:328-335. [PMID: 29489923 DOI: 10.12788/jhm.2949] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Bacterial bloodstream infections (BSIs) are a major cause of morbidity and mortality in the United States. Traditionally, BSIs have been managed with intravenous antimicrobials. However, whether intravenous antimicrobials are necessary for the entirety of the treatment course in BSIs, especially for uncomplicated episodes, is a more controversial matter. Patients that are clinically stable, without signs of shock, or have been stabilized after an initial septic presentation, may be appropriate candidates for treatment of BSIs with oral antimicrobials. There are risks and costs associated with extended courses of intravenous agents, such as the necessity for long-term intravenous catheters, which entail risks for procedural complications, secondary infections, and thrombosis. Oral antimicrobial therapy for bacterial BSIs offers several potential benefits. When selected appropriately, oral antibiotics offer lower cost, fewer side effects, promote antimicrobial stewardship, and are easier for patients. The decision to use oral versus intravenous antibiotics must consider the characteristics of the pathogen, the patient, and the drug. In this narrative review, the authors highlight areas where oral therapy is a safe and effective choice to treat bloodstream infection, and offer guidance and cautions to clinicians managing patients experiencing BSI.
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Affiliation(s)
- Andrew J Hale
- Department of Infectious Diseases,University of Vermont Medical Center, Burlington, Vermont, USA.
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - Graham M Snyder
- Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - John W Ahern
- Department of Pharmacy, University of Vermont Medical Center, Burlington, Vermont, USA
- Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
| | - George Eliopoulos
- Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Ricotta
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Hospitalist, Beth Israel Medical Center, Boston, Massachusetts, USA
| | - W Kemper Alston
- Department of Infectious Diseases,University of Vermont Medical Center, Burlington, Vermont, USA
- Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington, Vermont, USA
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Teatero S, McGeer A, Tyrrell GJ, Hoang L, Smadi H, Domingo MC, Levett PN, Finkelstein M, Dewar K, Plevneshi A, Athey TBT, Gubbay JB, Mulvey MR, Martin I, Demczuk W, Fittipaldi N. Canada-Wide Epidemic of emm74 Group A Streptococcus Invasive Disease. Open Forum Infect Dis 2018; 5:ofy085. [PMID: 29780850 DOI: 10.1093/ofid/ofy085] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 04/17/2018] [Indexed: 11/14/2022] Open
Abstract
Background The number of invasive group A Streptococcus (iGAS) infections due to hitherto extremely rare type emm74 strains has increased in several Canadian provinces since late 2015. We hypothesized that the cases recorded in the different provinces are linked and caused by strains of an emm74 clone that recently emerged and expanded explosively. Methods We analyzed both active and passive surveillance data for iGAS infections and used whole-genome sequencing to investigate the phylogenetic relationships of the emm74 strains responsible for these invasive infections country-wide. Results Genome analysis showed that highly clonal emm74 strains, genetically different from emm74 organisms previously circulating in Canada, were responsible for a country-wide epidemic of >160 invasive disease cases. The emerging clone belonged to multilocus sequence typing ST120. The analysis also revealed dissemination patterns of emm74 subclonal lineages across Canadian provinces. Clinical data analysis indicated that the emm74 epidemic disproportionally affected middle-aged or older male individuals. Homelessness, alcohol abuse, and intravenous drug usage were significantly associated with invasive emm74 infections. Conclusions In a period of 20 months, an emm74 GAS clone emerged and rapidly spread across several Canadian provinces located more than 4500 km apart, causing invasive infections primarily among disadvantaged persons.
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Affiliation(s)
- Sarah Teatero
- Public Health Ontario Laboratory, Toronto, ON, Canada
| | - Allison McGeer
- Sinai Health System, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Gregory J Tyrrell
- Alberta Provincial Laboratory for Public Health, and Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Linda Hoang
- British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, BC, Canada
| | - Hanan Smadi
- New Brunswick Department of Health, Communicable Disease and Control, Fredericton, NB, Canada
| | - Marc-Christian Domingo
- Laboratoire de Santé Publique du Québec, Institut National de Santé Publique du Québec, Ste-Anne de Bellevue, QC, Canada
| | - Paul N Levett
- Saskatchewan Disease Control Laboratory, Regina, SK, Canada
| | | | - Ken Dewar
- Genome Québec Innovation Centre, and McGill University, Montreal, QC, Canada
| | | | | | - Jonathan B Gubbay
- Public Health Ontario Laboratory, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michael R Mulvey
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Irene Martin
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Walter Demczuk
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Nahuel Fittipaldi
- Public Health Ontario Laboratory, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Ermert D, Weckel A, Magda M, Mörgelin M, Shaughnessy J, Rice PA, Björck L, Ram S, Blom AM. Human IgG Increases Virulence of Streptococcus pyogenes through Complement Evasion. THE JOURNAL OF IMMUNOLOGY 2018; 200:3495-3505. [PMID: 29626087 DOI: 10.4049/jimmunol.1800090] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/12/2018] [Indexed: 12/21/2022]
Abstract
Streptococcus pyogenes is an exclusively human pathogen that can provoke mild skin and throat infections but can also cause fatal septicemia. This gram-positive bacterium has developed several strategies to evade the human immune system, enabling S. pyogenes to survive in the host. These strategies include recruiting several human plasma proteins, such as the complement inhibitor, C4b-binding protein (C4BP), and human (hu)-IgG through its Fc region to the bacterial surface to evade immune recognition. We identified a novel virulence mechanism whereby IgG-enhanced binding of C4BP to five of 12 tested S. pyogenes strains expressed diverse M proteins that are important surface-expressed virulence factors. Importantly, all strains that bound C4BP in the absence of IgG bound more C4BP when IgG was present. Further studies with an M1 strain that additionally expressed protein H, also a member of the M protein family, revealed that binding of hu-IgG Fc to protein H increased the affinity of protein H for C4BP. Increased C4BP binding accentuated complement downregulation, resulting in diminished bacterial killing. Accordingly, mortality from S. pyogenes infection in hu-C4BP transgenic mice was increased when hu-IgG or its Fc portion alone was administered concomitantly. Electron microscopy analysis of human tissue samples with necrotizing fasciitis confirmed increased C4BP binding to S. pyogenes when IgG was present. Our findings provide evidence of a paradoxical function of hu-IgG bound through Fc to diverse S. pyogenes isolates that increases their virulence and may counteract the beneficial effects of IgG opsonization.
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Affiliation(s)
- David Ermert
- Division of Medical Protein Chemistry, Department of Translational Medicine, Lund University, 214 28 Malmo, Sweden; .,Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01605; and
| | - Antonin Weckel
- Division of Medical Protein Chemistry, Department of Translational Medicine, Lund University, 214 28 Malmo, Sweden
| | - Michal Magda
- Division of Medical Protein Chemistry, Department of Translational Medicine, Lund University, 214 28 Malmo, Sweden
| | - Matthias Mörgelin
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, 221 84 Lund, Sweden
| | - Jutamas Shaughnessy
- Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01605; and
| | - Peter A Rice
- Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01605; and
| | - Lars Björck
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, 221 84 Lund, Sweden
| | - Sanjay Ram
- Division of Infectious Diseases and Immunology, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01605; and
| | - Anna M Blom
- Division of Medical Protein Chemistry, Department of Translational Medicine, Lund University, 214 28 Malmo, Sweden
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64
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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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Raynes JM, Young PG, Proft T, Williamson DA, Baker EN, Moreland NJ. Protein adhesins as vaccine antigens for Group A Streptococcus. Pathog Dis 2018; 76:4919728. [DOI: 10.1093/femspd/fty016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/01/2018] [Indexed: 12/20/2022] Open
Affiliation(s)
- J M Raynes
- School of Medical Sciences, The University of Auckland, 85 Park Road, Auckland 1023, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, The University of Auckland, 3A Symonds Street, Auckland 1010, New Zealand
| | - P G Young
- Maurice Wilkins Centre for Molecular Biodiscovery, The University of Auckland, 3A Symonds Street, Auckland 1010, New Zealand
- School of Biological Sciences, University of Auckland, 5 Symonds Street, Auckland 1010, New Zealand
| | - T Proft
- School of Medical Sciences, The University of Auckland, 85 Park Road, Auckland 1023, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, The University of Auckland, 3A Symonds Street, Auckland 1010, New Zealand
| | - D A Williamson
- Microbiological Diagnostic Unit Public Health Laboratory, Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria 3000, Australia
| | - E N Baker
- Maurice Wilkins Centre for Molecular Biodiscovery, The University of Auckland, 3A Symonds Street, Auckland 1010, New Zealand
- School of Biological Sciences, University of Auckland, 5 Symonds Street, Auckland 1010, New Zealand
| | - N J Moreland
- School of Medical Sciences, The University of Auckland, 85 Park Road, Auckland 1023, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, The University of Auckland, 3A Symonds Street, Auckland 1010, New Zealand
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Abstract
Staphylococcal and streptococcal toxic shock syndrome (TSS) are associated with significant morbidity and mortality. There has been considerable progress in understanding the pathophysiology and delineating optimal management and treatment. This article reviews the management of TSS, outlining the 'Seven Rs of Managing and Treating TSS': Recognition, Resuscitation, Removal of source of infection, Rational choice of antibiotics, Role of adjunctive treatment (clindamycin and intravenous immunoglobulin), Review of progress and Reduce risk of secondary cases in close contacts.
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Affiliation(s)
- Amanda L Wilkins
- Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Australia
| | - Andrew C Steer
- Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Australia; Infectious Diseases & Microbiology and Group A Streptococcal Research Groups, Murdoch Children's Research Institute, Parkville, Australia; Centre for International Child Health, University of Melbourne, Melbourne, Australia
| | - Pierre R Smeesters
- Centre for International Child Health, University of Melbourne, Melbourne, Australia; Paediatric Department, Academic Children Hospital Queen Fabiola, Université Libre de Bruxelles, Brussels, Belgium; Molecular Bacteriology Laboratory, Université Libre de Bruxelles, Brussels, Belgium
| | - Nigel Curtis
- Infectious Diseases Unit, The Royal Children's Hospital Melbourne, Parkville, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Australia; Infectious Diseases & Microbiology and Group A Streptococcal Research Groups, Murdoch Children's Research Institute, Parkville, Australia.
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67
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Gottlieb M, Long B, Koyfman A. The Evaluation and Management of Toxic Shock Syndrome in the Emergency Department: A Review of the Literature. J Emerg Med 2018; 54:807-814. [PMID: 29366615 DOI: 10.1016/j.jemermed.2017.12.048] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 12/17/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Toxic shock syndrome (TSS) is a severe, toxin-mediated illness that can mimic several other diseases and is lethal if not recognized and treated appropriately. OBJECTIVE This review provides an emergency medicine evidence-based summary of the current evaluation and treatment of TSS. DISCUSSION The most common etiologic agents are Staphylococcus aureus and Streptococcus pyogenes. Sources of TSS include postsurgical wounds, postpartum, postabortion, burns, soft tissue injuries, pharyngitis, and focal infections. Symptoms are due to toxin production and infection focus. Early symptoms include fever, chills, malaise, rash, vomiting, diarrhea, and hypotension. Diffuse erythema and desquamation may occur later in the disease course. Laboratory assessment may demonstrate anemia, thrombocytopenia, elevated liver enzymes, and abnormal coagulation studies. Diagnostic criteria are available to facilitate the diagnosis, but they should not be relied on for definitive diagnosis. Rather, specific situations should trigger consideration of this disease process. Treatment involves intravenous fluids, source control, and antibiotics. Antibiotics should include a penicillinase-resistant penicillin, cephalosporin, or vancomycin (in methicillin-resistant S. aureus prevalent areas) along with either clindamycin or linezolid. CONCLUSION TSS is a potentially deadly disease requiring prompt recognition and treatment. Focused history, physical examination, and laboratory testing are important for the diagnosis and management of this disease. Understanding the evaluation and treatment of TSS can assist providers with effectively managing these patients.
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Affiliation(s)
- Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois
| | - Brit Long
- Department of Emergency Medicine, San Antonio Military Medical Center, Fort Sam Houston, Texas
| | - Alex Koyfman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas
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Chalker VJ, Smith A, Al-Shahib A, Botchway S, Macdonald E, Daniel R, Phillips S, Platt S, Doumith M, Tewolde R, Coelho J, Jolley KA, Underwood A, McCarthy ND. Integration of Genomic and Other Epidemiologic Data to Investigate and Control a Cross-Institutional Outbreak of Streptococcus pyogenes. Emerg Infect Dis 2018; 22:973-80. [PMID: 27192043 PMCID: PMC4880081 DOI: 10.3201/eid2206.142050] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Single-strain outbreaks of Streptococcus pyogenes infections are common and often go undetected. In 2013, two clusters of invasive group A Streptococcus (iGAS) infection were identified in independent but closely located care homes in Oxfordshire, United Kingdom. Investigation included visits to each home, chart review, staff survey, microbiologic sampling, and genome sequencing. S. pyogenes emm type 1.0, the most common circulating type nationally, was identified from all cases yielding GAS isolates. A tailored whole-genome reference population comprising epidemiologically relevant contemporaneous isolates and published isolates was assembled. Data were analyzed independently using whole-genome multilocus sequencing and single-nucleotide polymorphism analyses. Six isolates from staff and residents of the homes formed a single cluster that was separated from the reference population by both analytical approaches. No further cases occurred after mass chemoprophylaxis and enhanced infection control. Our findings demonstrate the ability of 2 independent analytical approaches to enable robust conclusions from nonstandardized whole-genome analysis to support public health practice.
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69
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Mearkle R, Saavedra-Campos M, Lamagni T, Usdin M, Coelho J, Chalker V, Sriskandan S, Cordery R, Rawlings C, Balasegaram S. Household transmission of invasive group A Streptococcus infections in England: a population-based study, 2009, 2011 to 2013. ACTA ACUST UNITED AC 2017; 22:30532. [PMID: 28537550 PMCID: PMC5476984 DOI: 10.2807/1560-7917.es.2017.22.19.30532] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 12/21/2016] [Indexed: 11/23/2022]
Abstract
Invasive group A streptococcal infection has a 15% case fatality rate and a risk of secondary transmission. This retrospective study used two national data sources from England; enhanced surveillance (2009) and a case management system (2011–2013) to identify clusters of severe group A streptococcal disease. Twenty-four household pairs were identified. The median onset interval between cases was 2 days (range 0–28) with simultaneous onset in eight pairs. The attack rate during the 30 days after first exposure to a primary case was 4,520 per 100,000 person-years at risk (95% confidence interval (CI): 2,900–6,730) a 1,940 (95% CI: 1,240–2,880) fold elevation over the background incidence. The theoretical number needed to treat to prevent one secondary case using antibiotic prophylaxis was 271 overall (95% CI: 194–454), 50 for mother-neonate pairs (95% CI: 27–393) and 82 for couples aged 75 years and over (95% CI: 46–417). While a dramatically increased risk of infection was noted in all household contacts, increased risk was greatest for mother-neonate pairs and couples aged 75 and over, suggesting targeted prophylaxis could be considered. Offering prophylaxis is challenging due to the short time interval between cases emphasising the importance of immediate notification and assessment of contacts.
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Affiliation(s)
- Rachel Mearkle
- Field Epidemiology Services, South East and London, National Infection Service, Public Health England, England
| | - Maria Saavedra-Campos
- Field Epidemiology Services, South East and London, National Infection Service, Public Health England, England
| | - Theresa Lamagni
- Healthcare-Associated Infection and Antimicrobial Resistance Department, National Infection Service, Public Health England, England
| | | | - Juliana Coelho
- Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England, England
| | - Vicki Chalker
- Respiratory and Vaccine Preventable Bacteria Reference Unit, Public Health England, England
| | - Shiranee Sriskandan
- NIHR Health Protection Research Unit in HCAI and AMR, Imperial College London, England
| | - Rebecca Cordery
- South London Health Protection Team, Public Health England, England
| | - Chas Rawlings
- Field Epidemiology Services, South East and London, National Infection Service, Public Health England, England
| | - Sooria Balasegaram
- Field Epidemiology Services, South East and London, National Infection Service, Public Health England, England
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70
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Strom MA, Hsu DY, Silverberg JI. Prevalence, comorbidities and mortality of toxic shock syndrome in children and adults in the USA. Microbiol Immunol 2017; 61:463-473. [DOI: 10.1111/1348-0421.12539] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/11/2017] [Accepted: 09/07/2017] [Indexed: 02/01/2023]
Affiliation(s)
- Mark A. Strom
- Department of Dermatology; Feinberg School of Medicine at Northwestern University; 676 N Saint Clair, St Suite 1600 Chicago IL 60611 USA
| | - Derek Y. Hsu
- Department of Dermatology; Feinberg School of Medicine at Northwestern University; 676 N Saint Clair, St Suite 1600 Chicago IL 60611 USA
| | - Jonathan I. Silverberg
- Departments of Dermatology; Preventive Medicine and Medical Social Sciences; Feinberg School of Medicine at Northwestern University; 676 N Saint Clair, St Suite 1600 Chicago IL 60611 USA
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71
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Kerr DL, Loraas EK, Links AC, Brogan TV, Schmale GA. Toxic shock in children with bone and joint infections: a review of seven years of patients admitted to one intensive care unit. J Child Orthop 2017; 11:387-392. [PMID: 29081854 PMCID: PMC5643933 DOI: 10.1302/1863-2548.11.170058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE The objective of this study was to compare the frequency of severe systemic, multi-organ involvement and toxic shock syndrome (TSS) in patients with Staphylococcus aureus (SA) and Group A β-haemolytic Streptococcus pyogenes (GABS) bone and joint infections. METHODS We retrospectively reviewed patients treated for septic arthritis or osteomyelitis at one children's hospital between 2002 and 2009. The rates of intensive care unit (ICU) admission for methicillin-sensitive SA (MSSA), methicillin-resistant SA (MRSA) and GABS infections were compared, as were the lengths of stay, number of surgeries, operative procedures and cases of TSS. RESULTS A total of 16 of 208 patients (7.7%) with culture-positive bone or joint infections were admitted to the ICU for critical illness: more commonly for patients with GABS infection (7/21 or 33%) than those with SA infection (6/132 or 5%) (odds ratio 10.55, 95% confidence interval 3.093 to 35.65, p = 0.0002). Patients with MRSA infections were significantly more likely to need ICU care than those with MSSA infection (p = 0.0009). Six of the ICU patients met the Centers for Disease Control and Prevention criteria for TSS. ICU patients with MRSA and GABS bone and joint infections had similar hospital courses: numerous surgeries (mean three per patient); procedures performed (mean 11 per patient); and prolonged hospital stays. CONCLUSION We found a greater likelihood of patients developing severe, multi-system involvement with bone and joint infections caused by GABS or MRSA when compared with MSSA. Early aggressive treatment of systemic shock and liberal decompressions of infected joints may limit the sequelae of these serious infections.
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Affiliation(s)
- D. L. Kerr
- Dartmouth-Hitchcock Medical Center,, Hanover, New Hampshire, USA
| | - E. K. Loraas
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - A. C. Links
- Kaiser Permanente Tacoma Medical Center, Tacoma, Washington, USA
| | - T. V. Brogan
- Seattle Children’s Hospital, Seattle, Washington, USA
| | - G. A. Schmale
- University of Washington School of Medicine, Seattle, Washington, USA,Correspondence should be sent to: G. A. Schmale, Seattle Children’s Hospital, M/S MB.10.620, 4800 Sand Point Way NE, Seattle, WA 98145-5005, USA. E-mail:
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72
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Estimating the risk of invasive group A Streptococcus infection in care home residents in England, 2009-2010. Epidemiol Infect 2017; 145:2759-2765. [PMID: 28805176 DOI: 10.1017/s0950268817001674] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Invasive group A streptococcal (iGAS) infections cause severe disease and death, especially in residents of long-term care facilities (LTCFs). In order to inform iGAS prevention, we compared the risk of iGAS in LTCF residents and community residents. We identified LTCF residents among cases of iGAS from national surveillance (2009-2010) using postcode matching, and cases of hospital-acquired infections via hospital admission records. We used Poisson regression to calculate incidence rate ratios (IRR) and logistic regression to explore factors associated with case fatality rate (CFR). A total of 2741 laboratory-confirmed iGAS cases were matched to a hospital admission: 156 (6%) were defined as hospital-acquired. Out of the total cases, 96 (3·5%) were LTCF residents. Compared with community residents, LTCF residents over 75 years of age had a higher risk of iGAS infection (IRR = 1·7; 95% CI 1·3-2·1) and CFR (OR = 2·3; 95% CI 1·3-3·8). Amongst community-acquired cases, the risk of iGAS in LTCF residents between 75 and 84 years of age doubled (IRR = 2·7; 95% CI 1·8-3·9) compared with their community counterparts. The CFR among community-acquired cases was higher in LTCF residents than community residents (21% vs. 11%). Age remained associated with death in our final model. Our study showed that, even controlling for age, LTCF residents have a higher risk of acquiring and dying from iGAS. Whilst existing co-morbidities may explain this, it is reasonable to assume that the institutional setting may facilitate transmission. Therefore, cases in LTCF require prompt investigation together with a better understanding of factors contributing to the acquisition of infection.
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73
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Chua WC, Mazlan MZ, Ali S, Che Omar S, Wan Hassan WMN, Seevaunnantum SP, Mohd Zaini RH, Hassan MH, Muhd Besari A, Abd Rahman Z, Salmuna Ayub ZN, Abd Ghani S, Yaacob N, Wan Rosli WR. Post-partum streptococcal toxic shock syndrome associated with necrotizing fasciitis. IDCases 2017; 9:91-94. [PMID: 28725564 PMCID: PMC5506869 DOI: 10.1016/j.idcr.2017.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 05/04/2017] [Accepted: 05/04/2017] [Indexed: 01/22/2023] Open
Abstract
We report a fatal case of post-partum streptococcal toxic shock syndrome in a patient who was previously healthy and had presented to the emergency department with an extensive blistering ecchymotic lesions over her right buttock and thigh associated with severe pain. The pregnancy had been uncomplicated, and the mode of delivery had been spontaneous vaginal delivery with an episiotomy. She was found to have septicemic shock requiring high inotropic support. Subsequently, she was treated for necrotizing fasciitis, complicated by septicemic shock and multiple organ failures. A consensus was reached for extensive wound debridement to remove the source of infection; however, this approach was abandoned due to the patient's hemodynamic instability and the extremely high risks of surgery. Both the high vaginal swab and blister fluid culture revealed Group A beta hemolytic streptococcus infection. Intravenous carbapenem in combination with clindamycin was given. Other strategies attempted for streptococcal toxic removal included continuous veno-venous hemofiltration and administration of intravenous immunoglobulin. Unfortunately, the patient's condition worsened, and she succumbed to death on day 7 of hospitalization.
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Affiliation(s)
- Wei Chuan Chua
- Department of Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
| | - Mohd Zulfakar Mazlan
- Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
| | - Saedah Ali
- Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
| | - Sanihah Che Omar
- Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
| | - Wan Mohd Nazaruddin Wan Hassan
- Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
| | - S Praveena Seevaunnantum
- Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
| | - Rhendra Hardy Mohd Zaini
- Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
| | - Mohd Hasyizan Hassan
- Department of Anaesthesiology and Intensive Care, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
| | - Alwi Muhd Besari
- Department of Internal Medicine, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
| | - Zaidah Abd Rahman
- Department of Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
| | - Zeti Norfidiyati Salmuna Ayub
- Department of Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
| | - Sabrina Abd Ghani
- Department of Orthopaedic, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
| | - Normalinda Yaacob
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
| | - Wan Rosilawati Wan Rosli
- Department of Obstetrics & Gynaecology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia
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74
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Case Series Description and Genomic Characterization of Invasive Group A Streptococcal Infections in Pediatric Patients. Pediatr Infect Dis J 2017; 36:618-620. [PMID: 28030528 DOI: 10.1097/inf.0000000000001519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We report an unusual cluster of invasive group A Streptococcus infections in 6 pediatric patients and demonstrate that the strains were derived from diverse genetic backgrounds, confirming the occurrence of a community cluster rather than a clonal outbreak. Whole genome sequencing provided a rapid and comprehensive view of group A Streptococcus genotypes and helped guide our institutional response and public health maneuvers.
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75
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Leiblein M, Marzi I, Sander AL, Barker JH, Ebert F, Frank J. Necrotizing fasciitis: treatment concepts and clinical results. Eur J Trauma Emerg Surg 2017; 44:279-290. [PMID: 28484782 DOI: 10.1007/s00068-017-0792-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 04/18/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Necrotizing fasciitis is a life-threatening soft tissue infection characterized by a rapid spreading infection of the subcutaneous tissue and in particular the fascia. The management of infected tissues requires a rapid diagnosis, immediate aggressive surgical management and an extended debridement. In some cases early amputations of the affected tissues and maximum intensive care treatment, in case of sepsis, are required. Due to a rising number of cases we aimed to evaluate our patients in a retrospective review. METHOD All patients diagnosed with necrotizing fasciitis from 2014 to 2016 (21 months) in our level one trauma center were identified. Their charts were reviewed and data were analyzed in terms of demographic and social information, microbiological results, therapeutic course, socio-economic outcome and mortality. RESULTS We found 15 patients with necrotizing fasciitis. None of these died in the observation period. The mean number of surgical interventions was seven. Two patients underwent limb amputation; diabetes mellitus was assigned with a significant higher risk for amputation. The mean hospitalization was 32 days, including 8 days on intensive care unit. Of the discovered bacteria 93% were sensitive to the initial antibiotic treatment with Ampicillin, Clindamycin and Clont. CONCLUSION Surgical therapy is indicated if necrotizing fasciitis is suspected. Diabetes mellitus was a clinical predictor of limb amputation in patients with necrotizing fasciitis in our cohort. Aminopenicillin ± sulbactam in combination with clindamycin and/or metronidazole is recommended as initial calculated antibiotic treatment.
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Affiliation(s)
- M Leiblein
- Department of Trauma, Hand, and Reconstructive Surgery, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany.
| | - I Marzi
- Department of Trauma, Hand, and Reconstructive Surgery, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - A L Sander
- Department of Trauma, Hand, and Reconstructive Surgery, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - J H Barker
- Experimental Trauma and Orthopedic Surgery, Frankfurt Initiative for Regenerative Medicine, Goethe-Universität, Friedrichsheim gGmbH, 60528, Frankfurt/Main, Germany
| | - F Ebert
- Department of Trauma, Hand, and Reconstructive Surgery, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - J Frank
- Department of Trauma, Hand, and Reconstructive Surgery, Johann Wolfgang Goethe-University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
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Analysis of Serum Cytokines and Single-Nucleotide Polymorphisms of SOD1, SOD2, and CAT in Erysipelas Patients. J Immunol Res 2017; 2017:2157247. [PMID: 28512644 PMCID: PMC5420430 DOI: 10.1155/2017/2157247] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 03/21/2017] [Indexed: 12/13/2022] Open
Abstract
Increased free radical production had been documented in group A (β-hemolytic) streptococcus infection cases. Comparing 71 erysipelas patients to 55 age-matched healthy individuals, we sought for CAT, SOD1, and SOD2 single polymorphism mutation (SNPs) interactions with erysipelas' predisposition and serum cytokine levels in the acute and recovery phases of erysipelas infection. Whereas female patients had a higher predisposition to erysipelas, male patients were prone to having a facial localization of the infection. The presence of SOD1 G7958, SOD2 T2734, and CAT C262 alleles was linked to erysipelas' predisposition. T and C alleles of SOD2 T2734C individually were linked to patients with bullous and erythematous erysipelas, respectively. G and A alleles of SOD1 G7958A individually were associated with lower limbs and higher body part localizations of the infection, respectively. Serum levels of IL-1β, CCL11, IL-2Rα, CXCL9, TRAIL, PDGF-BB, and CCL4 were associated with symptoms accompanying the infection, while IL-6, IL-9, IL-10, IL-13, IL-15, IL-17, G-CSF, and VEGF were associated with predisposition and recurrence of erysipelas. While variations of IL-1β, IL-7, IL-8, IL-17, CCL5, and HGF were associated with the SOD2 T2734C SNP, variations of PDFG-BB and CCL2 were associated with the CAT C262T SNP.
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77
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Teatero S, Coleman BL, Beres SB, Olsen RJ, Kandel C, Reynolds O, Athey TBT, Musser JM, McGeer A, Fittipaldi N. Rapid Emergence of a New Clone Impacts the Population at Risk and Increases the Incidence of Type emm89 Group A Streptococcus Invasive Disease. Open Forum Infect Dis 2017; 4:ofx042. [PMID: 28470020 PMCID: PMC5407211 DOI: 10.1093/ofid/ofx042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/02/2017] [Indexed: 12/02/2022] Open
Abstract
Background Invasive group A Streptococcus (iGAS) disease caused by type emm89 strains has been increasing worldwide, driven by the emergence of an epidemic clonal variant (clade 3 emm89). The clinical characteristics of patients with emm89 iGAS disease, and in particular with clade 3 emm89 iGAS disease, are poorly described. Methods We used population-based iGAS surveillance data collected in metropolitan Toronto, Ontario, Canada during the period 2000–2014. We sequenced the genomes of 105 emm89 isolates representing all emm89 iGAS disease cases in the area during the period and 138 temporally matched emm89 iGAS isolates collected elsewhere in Ontario. Results Clades 1 and 2 and clade O, a newly discovered emm89 genetic variant, caused most cases of emm89 iGAS disease in metropolitan Toronto before 2008. After rapid emergence of new clade 3, previously circulating clades were purged from the population and the incidence of emm89 iGAS disease significantly increased from 0.14 per 100000 in 2000–2007 to 0.22 per 100000 in 2008–2014. Overall, emm89 organisms caused significantly more arthritis but less necrotizing fasciitis than strains of the more common type emm1. Other clinical presentations were soft tissue and severe respiratory tract infections. Clinical outcomes did not differ significantly between emm89 clades overall. However, clade 3 emm89 iGAS disease was more common in youth and middle-aged individuals. Conclusions The rapid shift in emm89 iGAS strain genetics in metropolitan Toronto has resulted in a significant increase in the incidence of emm89 iGAS disease, with noticeably higher rates of clade 3 disease in younger patients.
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Affiliation(s)
| | - Brenda L Coleman
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada.,Mount Sinai Hospital, Toronto, Canada; and
| | - Stephen B Beres
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Texas
| | - Randall J Olsen
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Texas
| | - Christopher Kandel
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada.,Mount Sinai Hospital, Toronto, Canada; and
| | | | | | - James M Musser
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Texas
| | - Allison McGeer
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada.,Mount Sinai Hospital, Toronto, Canada; and
| | - Nahuel Fittipaldi
- Public Health Ontario, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada
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Abu-Ashour W, Twells L, Valcour J, Randell A, Donnan J, Howse P, Gamble JM. The association between diabetes mellitus and incident infections: a systematic review and meta-analysis of observational studies. BMJ Open Diabetes Res Care 2017; 5:e000336. [PMID: 28761647 PMCID: PMC5530269 DOI: 10.1136/bmjdrc-2016-000336] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 02/03/2017] [Accepted: 03/21/2017] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To quantify the association between diabetes and the risk of incident infections by conducting a systematic review and meta-analysis. RESEARCH DESIGN AND METHODS Two reviewers independently screened articles identified from PubMed, EMBASE, Cochrane Library, IPA, and Web of Science databases. Cohort studies (CS) or case-control studies (CCS) evaluating the incidence of infections in adults with diabetes were included. Infections were classified as: skin and soft tissue, respiratory, blood, genitourinary, head and neck, gastrointestinal, bone, viral, and non-specified infections. Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale. Summary crude and adjusted OR with 95% CIs were calculated using random effects models, stratified by study design. Heterogeneity was measured using the I2statistic and explored using subgroup analyses. RESULTS A total of 345 (243 CS and 102 CCS) studies were included. Combining adjusted results from all CS, diabetes was associated with an increased incidence of skin (OR 1.94, 95% CI 1.78 to 2.12), respiratory (OR 1.35, 95% CI 1.28 to 1.43), blood (OR 1.72, 95% CI 1.48 to 2.00), genitourinary (OR 1.61, 95% CI 1.42 to 1.82), head and neck (OR 1.17, 95% CI 1.13 to 1.22), gastrointestinal (OR 1.48, 95% CI 1.40 to 1.57), viral (OR 1.29, 95% CI 1.13 to 1.46), and non-specified (OR 1.84, 95% CI 1.66 to 2.04) infections. A stronger association was observed among CCS: skin (OR 2.64, 95% CI 2.20 to 3.17), respiratory (OR 1.62, 95% CI 1.37 to 1.92), blood (OR 2.40, 95% CI 1.68 to 3.42), genitourinary (OR 2.59, 95% CI 1.60 to 4.17), gastrointestinal (OR 3.61, 95% CI 2.94 to 4.43), and non-specified (OR 3.53, 95% CI 2.62 to 4.75). CONCLUSION Diabetes is associated with an increased risk of multiple types of infections. A high degree of heterogeneity was observed; however, subgroup analysis decreased the amount of heterogeneity within most groups. Results were generally consistent across types of infections.
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Affiliation(s)
- Waseem Abu-Ashour
- School of Pharmacy, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Laurie Twells
- School of Pharmacy, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - James Valcour
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Amy Randell
- School of Pharmacy, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Jennifer Donnan
- School of Pharmacy, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - Patricia Howse
- Faculty of Medicine, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
| | - John-Michael Gamble
- School of Pharmacy, Memorial University of Newfoundland, St. John’s, Newfoundland and Labrador, Canada
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Abstract
Toxic shock syndrome (TSS) represents a heterogeneous group of disorders that results in hypotension, multiorgan system involvement, and a characteristic rash or soft tissue infection caused by staphylococcal or streptococcal exotoxins and enterotoxins. Staphylococcal TSS emerged in the late 1970s as an illness associated with highly absorbent tampons; subsequently it has been described with postoperative infections, burns, and various viral illnesses. Although the morbidity rate associated with staphylococcal TSS may be high, the mortality rate approximates 5%. Streptococcal TSS has emerged in the 1980s and into the 1990s as a disorder that results in rapid progression of soft tissue infection in the form of cellulitis, myositis, or necrotizing fasciitis due to pyogenic streptococcal group A exotoxin. The rapidity of progression of local infection to hypotension and multiorgan failure results in a mortality rate of 30–70%. In both forms of TSS, staphylococcal and streptococcal exotoxins function as superantigens, a unique mechanism of immune activation that results in an exuberant T-cell response and profound cytokine expression. The role of antibiotics is reviewed. The use of clindamycin in streptococcal TSS and the potential therapeutic role of intravenous immunoglobulin in both forms of this disorder are discussed as well.
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Affiliation(s)
- Paul F. Dellaripa
- Section of Pulmonary and Critical Care Medicine and Section of Rheumatology, Lahey Clinic Medical Center, Burlington, MA
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80
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Traverso F, Blanco A, Villalón P, Beratz N, Sáez Nieto JA, Lopardo H. Molecular characterization of invasive Streptococcus dysgalactiae subsp. equisimilis. Multicenter study: Argentina 2011-2012. Rev Argent Microbiol 2016; 48:279-289. [PMID: 28341023 DOI: 10.1016/j.ram.2016.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/01/2016] [Accepted: 07/31/2016] [Indexed: 11/27/2022] Open
Abstract
Streptococcus dysgalactiae subsp. equisimilis (SDSE) has virulence factors similar to those of Streptococcus pyogenes. Therefore, it causes pharyngitis and severe infections indistinguishable from those caused by the classic pathogen. The objectives of this study were: to know the prevalence of SDSE invasive infections in Argentina, to study the genetic diversity, to determine the presence of virulence genes, to study antibiotic susceptibility and to detect antibiotic resistance genes. Conventional methods of identification were used. Antibiotic susceptibility was determined by the disk diffusion and the agar dilution methods and the E-test. Twenty eight centers from 16 Argentinean cities participated in the study. Twenty three isolates (16 group G and 7 group C) were obtained between July 1 2011 and June 30 2012. Two adult patients died (8.7%). Most of the isolates were recovered from blood (60.9%). All isolates carried speJ and ssa genes. stG62647, stG653 and stG840 were the most frequent emm types. Nineteen different PFGE patterns were detected. All isolates were susceptible to penicillin and levofloxacin, 6 (26.1%) showed resistance or reduced susceptibility to erythromycin [1 mef(A), 3 erm(TR), 1 mef(A)+erm(TR) and 1 erm(TR)+erm(B)] and 7 (30.4%) were resistant or exhibited reduced susceptibility to tetracycline [2 tet(M), 5 tet(M)+tet(O)]. The prevalence in Argentina was of at least 23 invasive infections by SDSE. A wide genetic diversity was observed. All isolates carried speJ and ssa genes. Similarly to other studies, macrolide resistance (26.1%) was mainly associated to the MLSB phenotype.
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Affiliation(s)
- Fernando Traverso
- Servicio de Microbiología, Hospital de Pediatría Prof. Dr. Juan P Garrahan, Buenos Aires, Argentina; Nueva Clínica Chacabuco, Tandil, Buenos Aires, Argentina; Servicio de Neumotisiología, Tandil, Buenos Aires, Argentina.
| | - Alejandra Blanco
- Servicio de Microbiología, Hospital de Pediatría Prof. Dr. Juan P Garrahan, Buenos Aires, Argentina
| | - Pilar Villalón
- Centro Nacional de Microbiología ISCIII, Majadahonda, Madrid, Spain
| | - Noelia Beratz
- Servicio de Microbiología, Hospital de Pediatría Prof. Dr. Juan P Garrahan, Buenos Aires, Argentina
| | | | - Horacio Lopardo
- Servicio de Microbiología, Hospital de Pediatría Prof. Dr. Juan P Garrahan, Buenos Aires, Argentina
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Bachert BA, Choi SJ, LaSala PR, Harper TI, McNitt DH, Boehm DT, Caswell CC, Ciborowski P, Keene DR, Flores AR, Musser JM, Squeglia F, Marasco D, Berisio R, Lukomski S. Unique Footprint in the scl1.3 Locus Affects Adhesion and Biofilm Formation of the Invasive M3-Type Group A Streptococcus. Front Cell Infect Microbiol 2016; 6:90. [PMID: 27630827 PMCID: PMC5005324 DOI: 10.3389/fcimb.2016.00090] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 08/15/2016] [Indexed: 12/04/2022] Open
Abstract
The streptococcal collagen-like proteins 1 and 2 (Scl1 and Scl2) are major surface adhesins that are ubiquitous among group A Streptococcus (GAS). Invasive M3-type strains, however, have evolved two unique conserved features in the scl1 locus: (i) an IS1548 element insertion in the scl1 promoter region and (ii) a nonsense mutation within the scl1 coding sequence. The scl1 transcript is drastically reduced in M3-type GAS, contrasting with a high transcription level of scl1 allele in invasive M1-type GAS. This leads to a lack of Scl1 expression in M3 strains. In contrast, while scl2 transcription and Scl2 production are elevated in M3 strains, M1 GAS lack Scl2 surface expression. M3-type strains were shown to have reduced biofilm formation on inanimate surfaces coated with cellular fibronectin and laminin, and in human skin equivalents. Repair of the nonsense mutation and restoration of Scl1 expression on M3-GAS cells, restores biofilm formation on cellular fibronectin and laminin coatings. Inactivation of scl1 in biofilm-capable M28 and M41 strains results in larger skin lesions in a mouse model, indicating that lack of Scl1 adhesin promotes bacterial spread over localized infection. These studies suggest the uniquely evolved scl1 locus in the M3-type strains, which prevents surface expression of the major Scl1 adhesin, contributed to the emergence of the invasive M3-type strains. Furthermore these studies provide insight into the molecular mechanisms mediating colonization, biofilm formation, and pathogenesis of group A streptococci.
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Affiliation(s)
- Beth A Bachert
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University Morgantown, WV, USA
| | - Soo J Choi
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University Morgantown, WV, USA
| | - Paul R LaSala
- Department of Pathology, West Virginia University Morgantown, WV, USA
| | - Tiffany I Harper
- Department of Pathology, West Virginia University Morgantown, WV, USA
| | - Dudley H McNitt
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University Morgantown, WV, USA
| | - Dylan T Boehm
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University Morgantown, WV, USA
| | - Clayton C Caswell
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University Morgantown, WV, USA
| | - Pawel Ciborowski
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center Omaha, NE, USA
| | | | - Anthony R Flores
- Section of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Texas Children's HospitalHouston, TX, USA; Department of Pathology and Genomic Medicine, Center for Molecular and Translational Human Infectious Diseases Research, Houston Methodist Research Institute and Hospital SystemHouston, TX, USA
| | - James M Musser
- Department of Pathology and Genomic Medicine, Center for Molecular and Translational Human Infectious Diseases Research, Houston Methodist Research Institute and Hospital System Houston, TX, USA
| | - Flavia Squeglia
- Institute of Biostructures and Bioimaging, National Research Council Naples, Italy
| | - Daniela Marasco
- Department of Pharmacy, University of Naples Frederico II Naples, Italy
| | - Rita Berisio
- Institute of Biostructures and Bioimaging, National Research Council Naples, Italy
| | - Slawomir Lukomski
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University Morgantown, WV, USA
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82
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Nursing Home Outbreak of Invasive Group A Streptococcal Infections Caused by 2 Distinct Strains. Infect Control Hosp Epidemiol 2016. [DOI: 10.1017/s0195941700045677] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objective.To identify factors contributing to a cluster of deaths from invasive group A streptococcus (GAS) infection in a nursing home facility and to prevent additional cases.Design.Outbreak investigation.Setting.A 146-bed nursing home facility in northern Nevada.Methods.We defined a case as the isolation of GAS from a normally sterile site in a resident of nursing home A. To identify case patients, we reviewed resident records from nursing home A, the local hospital, and the hospital laboratory. We obtained oropharyngeal and skin lesion swabs from staff and residents to assess GAS colonization and performed emm typing on available isolates. To identify potential risk factors for transmission, we performed a cohort study and investigated concurrent illness among residents and surveyed staff regarding infection control practices.Results.Six residents met the case patient definition; 3 (50%) of them died. Among invasive GAS isolates available for analysis, 2 distinct strains were identified: emm11 (3 isolates) and emm89 (2 isolates). The rate of GAS carriage was 6% among residents and 4% among staff; carriage isolates were emm89 (8 isolates), emm11 (2 isolates), and emm1 (1 isolate). Concurrently, 35 (24%) of the residents developed a respiratory illness of unknown etiology; 41% of these persons died. Twenty-one (30%) of the surveyed employees did not always wash their hands before patient contacts, and 27 (38%) did not always wash their hands between patient contacts.Conclusions.Concurrent respiratory illness likely contributed to an outbreak of invasive GAS infection from 2 strains in a highly susceptible population. This outbreak highlights the importance of appropriate infection control measures, including respiratory hygiene practices, in nursing home facilities.
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83
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Corticosteroid therapy in critical illness due to seasonal and pandemic influenza. Can Respir J 2016; 22:271-4. [PMID: 26436911 DOI: 10.1155/2015/658434] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Survey data suggest that Canadian intensivists administer corticosteroids to critically ill patients primarily in response to airway obstruction, perceived risk for adrenal insufficiency and hemodynamic instability. OBJECTIVE To describe variables independently associated with systemic corticosteroid therapy during an influenza outbreak. METHODS The present analysis was retrospective cohort study involving critically ill patients with influenza in two Canadian cities. Hospital records were reviewed for critically ill patients treated in the intensive care units (ICUs) of eight hospitals in Canada during the 2008 to 2009 and 2009 to 2010 influenza outbreaks. Abstracted data included demographic information, symptoms at disease onset, chronic comorbidities and baseline illness severity scores. Corticosteroid use data were extracted for every ICU day and expressed as hydrocortisone dose equivalent in mg. Multivariable regression models were constructed to identify variables independently associated with corticosteroid therapy in the ICU. RESULTS The study cohort included 90 patients with a mean (± SD) age of 55.0 ± 17.3 years and Acute Physiology and Chronic Health Evaluation II score of 19.8 ± 8.3. Patients in 2009 to 2010 were younger with more severe lung injury but similar exposure to corticosteroids. Overall, 54% of patients received corticosteroids at a mean daily dose of 343 ± 330 mg of hydrocortisone for 8.5 ± 4.8 days. Variables independently associated with corticosteroid therapy in the ICU were history of airway obstruction (OR 4.8 [95% CI 1.6 to 14.9]) and hemodynamic instability (OR 4.6 [95% CI 1.2 to 17.8]). CONCLUSION Observational data revealed that hemodynamic instability and airway obstruction were associated with corticosteroid therapy in the critical care setting, similar to a recent survey of stated practice. Efforts to determine the effects of corticosteroids in the ICU for these specific clinical situations are warranted.
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84
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Siemens N, Chakrakodi B, Shambat SM, Morgan M, Bergsten H, Hyldegaard O, Skrede S, Arnell P, Madsen MB, Johansson L, Juarez J, Bosnjak L, Mörgelin M, Svensson M, Norrby-Teglund A. Biofilm in group A streptococcal necrotizing soft tissue infections. JCI Insight 2016; 1:e87882. [PMID: 27699220 DOI: 10.1172/jci.insight.87882] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Necrotizing fasciitis caused by group A streptococcus (GAS) is a life-threatening, rapidly progressing infection. At present, biofilm is not recognized as a potential problem in GAS necrotizing soft tissue infections (NSTI), as it is typically linked to chronic infections or associated with foreign devices. Here, we present a case of a previously healthy male presenting with NSTI caused by GAS. The infection persisted over 24 days, and the surgeon documented the presence of a "thick layer biofilm" in the fascia. Subsequent analysis of NSTI patient tissue biopsies prospectively included in a multicenter study revealed multiple areas of biofilm in 32% of the patients studied. Biopsies associated with biofilm formation were characterized by massive bacterial load, a pronounced inflammatory response, and clinical signs of more severe tissue involvement. In vitro infections of a human skin tissue model with GAS NSTI isolates also revealed multilayered fibrous biofilm structures, which were found to be under the control of the global Nra gene regulator. The finding of GAS biofilm formation in NSTIs emphasizes the urgent need for biofilm to be considered as a potential complicating microbiological feature of GAS NSTI and, consequently, emphasizes reconsideration of antibiotic treatment protocols.
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Affiliation(s)
- Nikolai Siemens
- Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Bhavya Chakrakodi
- Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Srikanth Mairpady Shambat
- Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Marina Morgan
- Department of Microbiology, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom
| | - Helena Bergsten
- Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Ole Hyldegaard
- Department of Anaesthesia, Rigshospitalet, Copenhagen, Denmark
| | - Steinar Skrede
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Per Arnell
- Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Martin B Madsen
- Department of Intensive Care, Rigshospitalet, Copenhagen, Denmark
| | - Linda Johansson
- Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | | | - Julius Juarez
- Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Lidija Bosnjak
- Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Matthias Mörgelin
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Mattias Svensson
- Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Norrby-Teglund
- Center for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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85
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Aliku T, Sable C, Scheel A, Tompsett A, Lwabi P, Okello E, McCarter R, Summar M, Beaton A. Targeted Echocardiographic Screening for Latent Rheumatic Heart Disease in Northern Uganda: Evaluating Familial Risk Following Identification of an Index Case. PLoS Negl Trop Dis 2016; 10:e0004727. [PMID: 27294545 PMCID: PMC4905680 DOI: 10.1371/journal.pntd.0004727] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 05/02/2016] [Indexed: 11/19/2022] Open
Abstract
Background Echocardiographic screening for detection of latent RHD has shown potential as a strategy to decrease the burden of disease. However, further research is needed to determine optimal implementation strategies. RHD results from a complex interplay between environment and host susceptibility. Family members share both and relatives of children with latent RHD may represent a high-risk group. The objective of this study was to use echocardiographic family screening to determine the relative risk of RHD among first-degree relatives of children with latent RHD compared to the risk in first-degree relatives of healthy peers. Methodology/Principal Findings Previous school-based screening data were used to identify RHD positive children and RHD negative peers. All first-degree relatives ≥ 5 years were invited for echocardiography screening (2012 World Heart Federation Criteria). Sixty RHD positive cases (30 borderline/30 definite RHD) and 67 RHD negative cases were recruited. A total of 455/667 (68%) family members were screened. Definite RHD was more common in childhood siblings of RHD positive compared to RHD negative (p = 0.05). Children with any RHD were 4.5 times as likely to have a sibling with definite RHD, a risk that increased to 5.6 times when considering only cases with definite RHD. Mothers of RHD positive and RHD negative cases had an unexpectedly high rate of latent RHD (9.3%). Conclusions/Significance Siblings of RHD positive cases with RHD are more likely to have definite RHD and the relative risk is highest if the index case has definite RHD. Future screening programs should consider implementation of sibling screening following detection of an RHD positive child. Larger screening studies of adults are needed, as data on prevalence of latent RHD outside of childhood are sparse. Future studies should prioritize implementation research to answer questions of how RHD screening can best be integrated into existing healthcare structures, ensuring practical and sustainable screening programs. Rheumatic heart disease (RHD) affects at least 33 million people, most of who live in low-resource environments. RHD is a cumulative process and there exists a latent period between early valve damage and presentation with symptoms. Echocardiographic screening (ultrasound of the heart) has proven highly sensitive for latent RHD detection, but implementation research is needed to effectively develop sustainable public health strategies. Critical to this research is determining whom to screen. As family members have both a shared environment and shared genetic susceptibility, they may represent a high-risk group that could be targeted once a case of RHD is identified. We conducted an echocardiographic family screening study to determine the risk of RHD in families with and without an RHD positive child and found that siblings of children with latent RHD are more likely to have latent RHD themselves. Our data suggest that siblings may represent a particularly high-risk group that could be targeted for echocardiographic screening. Future studies are needed to answer questions of how RHD screening can best be integrated into existing healthcare structures, ensuring practical and sustainable RHD screening programs.
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Affiliation(s)
- Twalib Aliku
- School of Medicine, Gulu University, Gulu, Uganda
| | - Craig Sable
- Division of Cardiology, Children’s National Health System, Washington, District of Columbia, United States of America
| | - Amy Scheel
- Division of Cardiology, Children’s National Health System, Washington, District of Columbia, United States of America
| | - Alison Tompsett
- Division of Cardiology, Children’s National Health System, Washington, District of Columbia, United States of America
| | | | - Emmy Okello
- Uganda Heart Institute, Kampala, Uganda
- School of Medicine, Makerere University, Kampala, Uganda
| | - Robert McCarter
- Division of Biostatistics and Informatics, Children’s National Health System, Washington, District of Columbia, United States of America
| | - Marshall Summar
- Division of Genetics and Metabolism, Children’s National Health System, Washington, District of Columbia, United States of America
| | - Andrea Beaton
- Division of Cardiology, Children’s National Health System, Washington, District of Columbia, United States of America
- * E-mail:
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Chalker VJ, Smith A, Al-Shahib A, Botchway S, Macdonald E, Daniel R, Phillips S, Platt S, Doumith M, Tewolde R, Coelho J, Jolley KA, Underwood A, McCarthy ND. Integration of Genomic and Other Epidemiologic Data to Investigate and Control a Cross-Institutional Outbreak of Streptococcus pyogenes. Emerg Infect Dis 2016. [DOI: 10.3201/eid2204.142050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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87
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Streptococcus pyogenes Pneumonia in Adults: Clinical Presentation and Molecular Characterization of Isolates 2006-2015. PLoS One 2016; 11:e0152640. [PMID: 27027618 PMCID: PMC4814053 DOI: 10.1371/journal.pone.0152640] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/16/2016] [Indexed: 01/10/2023] Open
Abstract
Introduction In the preantibiotic era Streptococcus pyogenes was a common cause of severe pneumonia but currently, except for postinfluenza complications, it is not considered a common cause of community-acquired pneumonia in adults. Aim and Material and Methods This study aimed to identify current clinical episodes of S. pyogenes pneumonia, its relationship with influenza virus circulation and the genotypes of the involved isolates during a decade in a Southern European region (Gipuzkoa, northern Spain). Molecular analysis of isolates included emm, multilocus-sequence typing, and superantigen profile determination. Results Forty episodes were detected (annual incidence 1.1 x 100,000 inhabitants, range 0.29–2.29). Thirty-seven episodes were community-acquired, 21 involved an invasive infection and 10 developed STSS. The associated mortality rate was 20%, with half of the patients dying within 24 hours after admission. Influenza coinfection was confirmed in four patients and suspected in another. The 52.5% of episodes occurred outside the influenza seasonal epidemic. The 67.5% of affected persons were elderly individuals and adults with severe comorbidities, although 13 patients had no comorbidities, 2 of them had a fatal outcome. Eleven clones were identified, the most prevalent being emm1/ST28 (43.6%) causing the most severe cases. Conclusions S. pyogenes pneumonia had a continuous presence frequently unrelated to influenza infection, being rapidly fatal even in previously healthy individuals.
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Barth DD, Engel ME, Whitelaw A, Alemseged A, Sadoh WE, Ali SKM, Sow SO, Dale J, Mayosi BM. Rationale and design of the African group A streptococcal infection registry: the AFROStrep study. BMJ Open 2016; 6:e010248. [PMID: 26916694 PMCID: PMC4769387 DOI: 10.1136/bmjopen-2015-010248] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Group A β-haemolytic Streptococcus (GAS), a Gram-positive bacterium, also known as Streptococcus pyogenes, causes pyoderma, pharyngitis and invasive disease. Repeated GAS infections may lead to autoimmune diseases such as acute post-streptococcal glomerulonephritis, acute rheumatic fever (ARF) and rheumatic heart disease (RHD). Invasive GAS (iGAS) disease is an important cause of mortality and morbidity worldwide. The burden of GAS infections is, however, unknown in Africa because of lack of surveillance systems. METHODS AND ANALYSIS The African group A streptococcal infection registry (the AFROStrep study) is a collaborative multicentre study of clinical, microbiological, epidemiological and molecular characteristics for GAS infection in Africa. The AFROStrep registry comprises two components: (1) active surveillance of GAS pharyngitis cases from sentinel primary care centres (non-iGAS) and (2) passive surveillance of iGAS disease from microbiology laboratories. Isolates will also be subjected to DNA isolation to allow for characterisation by molecular methods and cryopreservation for long-term storage. The AFROStrep study seeks to collect comprehensive data on GAS isolates in Africa. The biorepository will serve as a platform for vaccine development in Africa. ETHICS AND DISSEMINATION Ethics approval for the AFROStrep registry has been obtained from the Human Research Ethics Committee at the University of Cape Town (HREC/REF: R006/2015). Each recruiting site will seek ethics approval from their local ethics' committee. All participants will be required to provide consent for inclusion into the registry as well as for the storage of isolates and molecular investigations to be conducted thereon. Strict confidentiality will be applied throughout. Findings and updates will be disseminated to collaborators, researchers, health planners and colleagues through peer-reviewed journal articles, conference publications and proceedings.
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Affiliation(s)
- Dylan D Barth
- Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Mark E Engel
- Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Andrew Whitelaw
- Department of Microbiology, National Health Laboratory Service, Tygerberg Hospital and Stellenbosch University, Tygerberg, South Africa
| | - Abdissa Alemseged
- Department of Laboratory Sciences and Pathology, College of Health Sciences, Jimma University, Jimma, Ethiopia
| | - Wilson E Sadoh
- Department of Child Health, School of Medicine, University of Benin and University of Benin Teaching Hospital, Benin City, Nigeria
| | - Sulafa K M Ali
- Department of Pediatrics and Child Health, Faculty of Medicine, University of Khartoum and Sudan Heart Institute, Khartoum, Sudan
| | - Samba O Sow
- Centre pour le Développement des Vaccins—Mali, Bamako, Mali
| | - James Dale
- Department of Medicine, Division of Infectious Diseases, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Bongani M Mayosi
- Department of Medicine, Faculty of Health Sciences, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
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89
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Carr JP, Curtis N, Smeesters PR, Steer A. QUESTION 1: Are household contacts of patients with invasive group A streptococcal disease at higher risk of secondary infection? Arch Dis Child 2016; 101:198-201. [PMID: 26792903 DOI: 10.1136/archdischild-2015-309788] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Jeremy P Carr
- Infectious Diseases Unit, The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Nigel Curtis
- Infectious Diseases Unit, The Royal Children's Hospital, Parkville, Victoria, Australia Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Pierre R Smeesters
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia Murdoch Children's Research Institute, Parkville, Victoria, Australia Paediatric Department, Academic Children Hospital Queen Fabiola, Université Libre de Bruxelles, Brussels, Belgium
| | - Andrew Steer
- Infectious Diseases Unit, The Royal Children's Hospital, Parkville, Victoria, Australia Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia Murdoch Children's Research Institute, Parkville, Victoria, Australia
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90
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Abstract
BACKGROUND The incidence of invasive group A streptococcus (iGAS) infections varies in time and geographically for unknown reasons. We performed a nationwide survey to assess the population-based incidence rates and outcomes of children with iGAS infections. METHODS We collected data on patients from hospital discharge registries and the electronic databases of microbiological laboratories in Finland for the period 1996-2010. We then recorded the emm types or serotypes of the strains. The study physician visited all university clinics and collected the clinical data using the same data entry sheet. RESULTS We identified 151 children with iGAS infection. Varicella preceded iGAS infection in 20% of cases and fasciitis infection in 83% of cases. The annual incidence rate of iGAS infection was 0.93 per 100,000 in 1996-2000, 1.80 in 2001-2005 and 2.50 in 2006-2010. The proportion of emm 1.0 or T1M1 strains peaked in 1996-2000 and again in 2006-2010, to 44% and 37% of all typed isolates. The main clinical diagnoses of the patients were severe soft-tissue infection (46%), sepsis (28%), empyema (10%), osteoarticular infection (9%) and primary peritonitis (5%). Severe pain was the most typical symptom for soft-tissue infections. More than half of the patients underwent surgery and received clindamycin. The readmission rate was 7%, and the case fatality rate was 2%. CONCLUSIONS The incidence rate of pediatric iGAS infections tripled during our study. The increase was not, however, the result of a change in the strain types causing iGAS. Varicella immunization would likely have prevented a significant number of the cases.
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91
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High Incidence of Invasive Group A Streptococcus Disease Caused by Strains of Uncommon emm Types in Thunder Bay, Ontario, Canada. J Clin Microbiol 2015; 54:83-92. [PMID: 26491184 DOI: 10.1128/jcm.02201-15] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Accepted: 10/15/2015] [Indexed: 12/26/2022] Open
Abstract
An outbreak of type emm59 invasive group A Streptococcus (iGAS) disease was declared in 2008 in Thunder Bay District, Northwestern Ontario, 2 years after a countrywide emm59 epidemic was recognized in Canada. Despite a declining number of emm59 infections since 2010, numerous cases of iGAS disease continue to be reported in the area. We collected clinical information on all iGAS cases recorded in Thunder Bay District from 2008 to 2013. We also emm typed and sequenced the genomes of all available strains isolated from 2011 to 2013 from iGAS infections and from severe cases of soft tissue infections. We used whole-genome sequencing data to investigate the population structure of GAS strains of the most frequently isolated emm types. We report an increased incidence of iGAS in Thunder Bay compared to the metropolitan area of Toronto/Peel and the province of Ontario. Illicit drug use, alcohol abuse, homelessness, and hepatitis C infection were underlying diseases or conditions that might have predisposed patients to iGAS disease. Most cases were caused by clonal strains of skin or generalist emm types (i.e., emm82, emm87, emm101, emm4, emm83, and emm114) uncommonly seen in other areas of the province. We observed rapid waxing and waning of emm types causing disease and their replacement by other emm types associated with the same tissue tropisms. Thus, iGAS disease in Thunder Bay District predominantly affects a select population of disadvantaged persons and is caused by clonally related strains of a few skin and generalist emm types less commonly associated with iGAS in other areas of Ontario.
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92
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High burden of invasive group A streptococcal disease in the Northern Territory of Australia. Epidemiol Infect 2015; 144:1018-27. [PMID: 26364646 DOI: 10.1017/s0950268815002010] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Although the incidence of invasive group A streptococcal disease in northern Australia is very high, little is known of the regional epidemiology and molecular characteristics. We conducted a case series of Northern Territory residents reported between 2011 and 2013 with Streptococcus pyogenes isolates from a normally sterile site. Of the 128 reported episodes, the incidence was disproportionately high in the Indigenous population at 69·7/100 000 compared to 8·8/100 000 in the non-Indigenous population. Novel to the Northern Territory is the extremely high incidence in haemodialysis patients of 2205·9/100 000 population; and for whom targeted infection control measures could prevent transmission. The incidences in the tropical north and semi-arid Central Australian regions were similar. Case fatality was 8% (10/128) and streptococcal toxic shock syndrome occurred in 14 (11%) episodes. Molecular typing of 82 isolates identified 28 emm types, of which 63 (77%) were represented by four emm clusters. Typing confirmed transmission between infant twins. While the diverse range of emm types presents a challenge for effective coverage by vaccine formulations, the limited number of emm clusters raises optimism should cluster-specific cross-protection prove efficacious. Further studies are required to determine effectiveness of chemoprophylaxis for contacts and to inform public health response.
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93
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Abstract
INTRODUCTION Streptococci are a genus of Gram-positive bacteria which cause diverse human diseases. Many of these species have the potential to cause invasive infection resulting from the presence of bacteria in a normally sterile site. SOURCES OF DATA Original articles, reviews and guidelines. AREAS OF AGREEMENT Invasive infection by a streptococcus species usually causes life-threatening illness. When measured in terms of deaths, disability and cost, these infections remain an important threat to health in the UK. Overall they are becoming more frequent among the elderly and those with underlying chronic illness. New observational evidence has become available to support the use of clindamycin and intravenous immunoglobulin in invasive Group A streptococcal disease. AREAS OF CONTROVERSY Few interventions for the treatment and prevention of these infections have undergone rigorous evaluation in clinical trials. For example, the role of preventative strategies such as screening of pregnant women to prevent neonatal invasive Group B streptococcal disease needs to be clarified. FUTURE PROSPECTS Studies of invasive streptococcal disease are challenging to undertake, not least because individual hospitals treat relatively few confirmed cases. Instead clinicians and scientists must work together to build national and international networks with the aim of developing a more complete evidence base for the treatment and prevention of these devastating infections.
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Affiliation(s)
- Tom Parks
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Lucinda Barrett
- Department of Microbiology and Infectious Diseases, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Nicola Jones
- Department of Microbiology and Infectious Diseases, Oxford University Hospitals NHS Trust, Oxford, UK
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94
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Gershon AA, Breuer J, Cohen JI, Cohrs RJ, Gershon MD, Gilden D, Grose C, Hambleton S, Kennedy PGE, Oxman MN, Seward JF, Yamanishi K. Varicella zoster virus infection. Nat Rev Dis Primers 2015; 1:15016. [PMID: 27188665 PMCID: PMC5381807 DOI: 10.1038/nrdp.2015.16] [Citation(s) in RCA: 393] [Impact Index Per Article: 43.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Infection with varicella zoster virus (VZV) causes varicella (chickenpox), which can be severe in immunocompromised individuals, infants and adults. Primary infection is followed by latency in ganglionic neurons. During this period, no virus particles are produced and no obvious neuronal damage occurs. Reactivation of the virus leads to virus replication, which causes zoster (shingles) in tissues innervated by the involved neurons, inflammation and cell death - a process that can lead to persistent radicular pain (postherpetic neuralgia). The pathogenesis of postherpetic neuralgia is unknown and it is difficult to treat. Furthermore, other zoster complications can develop, including myelitis, cranial nerve palsies, meningitis, stroke (vasculopathy), retinitis, and gastroenterological infections such as ulcers, pancreatitis and hepatitis. VZV is the only human herpesvirus for which highly effective vaccines are available. After varicella or vaccination, both wild-type and vaccine-type VZV establish latency, and long-term immunity to varicella develops. However, immunity does not protect against reactivation. Thus, two vaccines are used: one to prevent varicella and one to prevent zoster. In this Primer we discuss the pathogenesis, diagnosis, treatment, and prevention of VZV infections, with an emphasis on the molecular events that regulate these diseases. For an illustrated summary of this Primer, visit: http://go.nature.com/14xVI1.
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Affiliation(s)
- Anne A Gershon
- Columbia University College of Physicians and Surgeons, 630 West 168th Street, New York, New York 10032, USA
| | - Judith Breuer
- Department of Infection and Immunity, University College London, UK
| | - Jeffrey I Cohen
- Medical Virology Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Massachusetts, USA
| | - Randall J Cohrs
- Departments of Neurology and Microbiology and Immunology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Michael D Gershon
- Department of Pathology and Cell Biology, Columbia University College of Physicians and Surgeons, New York, New York, USA
| | - Don Gilden
- Departments of Neurology and Microbiology and Immunology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Charles Grose
- Division of Infectious Diseases/Virology, Children's Hospital, University of Iowa, Iowa City, Iowa, USA
| | - Sophie Hambleton
- Primary Immunodeficiency Group, Institute of Cellular Medicine, Newcastle University Medical School, Newcastle upon Tyne, UK
| | - Peter G E Kennedy
- Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow University, Glasgow, Scotland, UK
| | - Michael N Oxman
- Infectious Diseases Section, Medicine Service, Veterans Affairs San Diego Healthcare System, Division of Infectious Diseases, Department of Medicine, University of California San Diego School of Medicine, San Diego, California, USA
| | - Jane F Seward
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Koichi Yamanishi
- Research Foundation for Microbial Diseases, Osaka University, Suita, Osaka, Japan
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95
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Barra Quilez F, Vicente Gordo M, Barceló Castelló M, Araujo Aguilar P, Gurpegui Puente M, Tomás Marsilla I. Isquemia mesentérica masiva en paciente puerperal por shock tóxico estreptocócico. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2015. [DOI: 10.1016/j.gine.2014.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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96
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Shah PJ, Vakil N, Kabakov A. Role of intravenous immune globulin in streptococcal toxic shock syndrome andClostridium difficileinfection. Am J Health Syst Pharm 2015; 72:1013-9. [DOI: 10.2146/ajhp140359] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Punit J. Shah
- Alexian Brokers Health System, Elk Grove Village, IL; at the time of writing he was Antimicrobial Utilization Review Pharmacist, Cedars-Sinai Medical Center, Los Angeles, CA
| | | | - Anna Kabakov
- Department of Pharmacy Practice, Midwestern University Chicago College of Pharmacy, Downers Grove, IL, and Clinical Pharmacy Specialist, Internal Medicine, Presence Saint Joseph Hospital, Chicago, IL; at the time of writing she was Clinical Pharmacy Specialist, Internal Medicine, Captain James A. Lovell Federal Health Care Center, North Chicago, IL
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97
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Population-based epidemiology and microbiology of community-onset bloodstream infections. Clin Microbiol Rev 2015; 27:647-64. [PMID: 25278570 DOI: 10.1128/cmr.00002-14] [Citation(s) in RCA: 189] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Bloodstream infection (BSI) is a major cause of infectious disease morbidity and mortality worldwide. While a positive blood culture is mandatory for establishment of the presence of a BSI, there are a number of determinants that must be considered for establishment of this entity. Community-onset BSIs are those that occur in outpatients or are first identified <48 h after admission to hospital, and they may be subclassified further as health care associated, when they occur in patients with significant prior health care exposure, or community associated, in other cases. The most common causes of community-onset BSI include Escherichia coli, Staphylococcus aureus, and Streptococcus pneumoniae. Antimicrobial-resistant organisms, including methicillin-resistant Staphylococcus aureus and extended-spectrum β-lactamase/metallo-β-lactamase/carbapenemase-producing Enterobacteriaceae, have emerged as important etiologies of community-onset BSI.
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98
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Stetzner ZW, Li D, Feng W, Liu M, Liu G, Wiley J, Lei B. Serotype M3 and M28 Group A Streptococci Have Distinct Capacities to Evade Neutrophil and TNF-α Responses and to Invade Soft Tissues. PLoS One 2015; 10:e0129417. [PMID: 26047469 PMCID: PMC4457532 DOI: 10.1371/journal.pone.0129417] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 05/10/2015] [Indexed: 11/18/2022] Open
Abstract
The M3 Serotype of Group A Streptococcus (GAS) is one of the three most frequent serotypes associated with severe invasive GAS infections, such as necrotizing fasciitis, in the United States and other industrialized countries. The basis for this association and hypervirulence of invasive serotype M3 GAS is not fully understood. In this study, the sequenced serotype M3 strain, MGAS315, and serotype M28 strain, MGAS6180, were characterized in parallel to determine whether contemporary M3 GAS has a higher capacity to invade soft tissues than M28 GAS. In subcutaneous infection, MGAS315 invaded almost the whole skin, inhibited neutrophil recruitment and TNF-α production, and was lethal in subcutaneous infection of mice, whereas MGAS6180 did not invade skin, induced robust neutrophil infiltration and TNF-α production, and failed to kill mice. In contrast to MGAS6180, MGAS315 had covS G1370T mutation. Either replacement of the covS1370T gene with wild-type covS in MGAS315 chromosome or in trans expression of wild-type covS in MGAS315 reduced expression of CovRS-controlled virulence genes hasA, spyCEP, and sse by >10 fold. MGAS315 covSwt lost the capacity to extensively invade skin and to inhibit neutrophil recruitment and had attenuated virulence, indicating that the covS G1370T mutation critically contribute to the hypervirulence of MGAS315. Under the background of functional CovRS, MGAS315 covSwt still caused greater lesions than MGAS6180, and, consistently under the background of covS deletion, MGAS6180 ΔcovS caused smaller lesions than MGAS315 ΔcovS. Thus, contemporary invasive M3 GAS has a higher capacity to evade neutrophil and TNF-α responses and to invade soft tissue than M28 GAS and that this skin-invading capacity of M3 GAS is maximized by natural CovRS mutations. These findings enhance our understanding of the basis for the frequent association of M3 GAS with necrotizing fasciitis.
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Affiliation(s)
- Zachary W. Stetzner
- Department of Microbiology and Immunology, Montana State University, Bozeman, Montana 59718, United States of America
| | - Dengfeng Li
- Department of Microbiology and Immunology, Montana State University, Bozeman, Montana 59718, United States of America
| | - Wenchao Feng
- Department of Microbiology and Immunology, Montana State University, Bozeman, Montana 59718, United States of America
| | - Mengyao Liu
- Department of Microbiology and Immunology, Montana State University, Bozeman, Montana 59718, United States of America
| | - Guanghui Liu
- Department of Microbiology and Immunology, Montana State University, Bozeman, Montana 59718, United States of America
| | - James Wiley
- Department of Microbiology and Immunology, Montana State University, Bozeman, Montana 59718, United States of America
| | - Benfang Lei
- Department of Microbiology and Immunology, Montana State University, Bozeman, Montana 59718, United States of America
- * E-mail:
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99
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Burnham JP, Kollef MH. Understanding toxic shock syndrome. Intensive Care Med 2015; 41:1707-10. [DOI: 10.1007/s00134-015-3861-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 05/04/2015] [Indexed: 10/23/2022]
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100
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Tarvade S, Lane AS. Ante-partum necrotising myometritis due to Streptococcal toxic shock. J Intensive Care Soc 2015; 16:172-178. [PMID: 28979401 DOI: 10.1177/1751143714565855] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Group A streptococcus (GAS) causes severe infections in obstetric patients. A rare complication is rapidly progressive necrotising myometritis. Postpartum necrotising myometritis has been previously described; however, antenatal development of such a condition is extremely rare. We present a patient who developed antenatal necrotising myometritis and toxic shock syndrome (TSS) due to GAS during the first trimester of pregnancy, eventually requiring hysterectomy and bilateral oophorectomy. We discuss the rare complication of ante-partum necrotising myometritis, as well as the antibiotic therapy, and treatment of TSS associated with severe Group A Streptococcal infections.
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Affiliation(s)
- Sanjay Tarvade
- Staff Specialist in Intensive Care Medicine, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Andrew S Lane
- Senior Lecturer in Intensive Care Medicine, Sydney Medical School, Sydney, NSW, Australia.,Staff Specialist in Intensive Care Medicine, Nepean Hospital, Sydney, NSW, Australia
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