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Ramírez de Arellano E, Saavedra-Lozano J, Villalón P, Jové-Blanco A, Grandioso D, Sotelo J, Gamell A, González-López JJ, Cervantes E, Gónzalez MJ, Rello-Saltor V, Esteva C, Sanz-Santaeufemia F, Yagüe G, Manzanares Á, Brañas P, Ruiz de Gopegui E, Carrasco-Colom J, García F, Cercenado E, Mellado I, Del Castillo E, Pérez-Vazquez M, Oteo-Iglesias J, Calvo C. Clinical, microbiological, and molecular characterization of pediatric invasive infections by Streptococcus pyogenes in Spain in a context of global outbreak. mSphere 2024; 9:e0072923. [PMID: 38440985 DOI: 10.1128/msphere.00729-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/15/2024] [Indexed: 03/06/2024] Open
Abstract
In December 2022, an alert was published in the UK and other European countries reporting an unusual increase in the incidence of Streptococcus pyogenes infections. Our aim was to describe the clinical, microbiological, and molecular characteristics of group A Streptococcus invasive infections (iGAS) in children prospectively recruited in Spain (September 2022-March 2023), and compare invasive strains with strains causing mild infections. One hundred thirty isolates of S. pyogenes causing infection (102 iGAS and 28 mild infections) were included in the microbiological study: emm typing, antimicrobial susceptibility testing, and sequencing for core genome multilocus sequence typing (cgMLST), resistome, and virulome analysis. Clinical data were available from 93 cases and 21 controls. Pneumonia was the most frequent clinical syndrome (41/93; 44.1%), followed by deep tissue abscesses (23/93; 24.7%), and osteoarticular infections (11/93; 11.8%). Forty-six of 93 cases (49.5%) required admission to the pediatric intensive care unit. iGAS isolates mainly belonged to emm1 and emm12; emm12 predominated in 2022 but was surpassed by emm1 in 2023. Spread of M1UK sublineage (28/64 M1 isolates) was communicated for the first time in Spain, but it did not replace the still predominant sublineage M1global (36/64). Furthermore, a difference in emm types compared with the mild cases was observed with predominance of emm1, but also important representativeness of emm12 and emm89 isolates. Pneumonia, the most frequent and severe iGAS diagnosed, was associated with the speA gene, while the ssa superantigen was associated with milder cases. iGAS isolates were mainly susceptible to antimicrobials. cgMLST showed five major clusters: ST28-ST1357/emm1, ST36-ST425/emm12, ST242/emm12.37, ST39/emm4, and ST101-ST1295/emm89 isolates. IMPORTANCE Group A Streptococcus (GAS) is a common bacterial pathogen in the pediatric population. In the last months of 2022, an unusual increase in GAS infections was detected in various countries. Certain strains were overrepresented, although the cause of this raise is not clear. In Spain, a significant increase in mild and severe cases was also observed; this study evaluates the clinical characteristics and the strains involved in both scenarios. Our study showed that the increase in incidence did not correlate with an increase in resistance or with an emm types shift. However, there seemed to be a rise in severity, partly related to a greater rate of pneumonia cases. These findings suggest a general increase in iGAS that highlights the need for surveillance. The introduction of whole genome sequencing in the diagnosis and surveillance of iGAS may improve the understanding of antibiotic resistance, virulence, and clones, facilitating its control and personalized treatment.
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Affiliation(s)
- Eva Ramírez de Arellano
- Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones Relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC). Instituto Salud Carlos III, Madrid, Spain
| | - Jesús Saavedra-Lozano
- CIBER de Enfermedades Infecciosas (CIBERINFEC). Instituto Salud Carlos III, Madrid, Spain
- Servicio de Pediatría, Hospital General Universitario Gregorio Marañón. Universidad Complutense, Madrid, Spain
| | - Pilar Villalón
- Laboratorio de Referencia e Investigación en Taxonomía, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - Ana Jové-Blanco
- Servicio de Pediatría, Hospital General Universitario Gregorio Marañón. Universidad Complutense, Madrid, Spain
| | - David Grandioso
- Servicio de Microbiología, Hospital Universitario La Paz, Madrid, Spain
| | - Jared Sotelo
- Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones Relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC). Instituto Salud Carlos III, Madrid, Spain
| | - Anna Gamell
- Servicio de Enfermedades Infecciosas, Hospital San Joan de Déu, Barcelona, Spain
| | - Juan José González-López
- CIBER de Enfermedades Infecciosas (CIBERINFEC). Instituto Salud Carlos III, Madrid, Spain
- Servicio de Microbiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Eloísa Cervantes
- Servicio de Pediatría, Hospital Virgen de la Arrixaca, Murcia, Spain
| | | | | | - Cristina Esteva
- Servicio de Microbiología, Hospital San Joan de Dèu, Barcelona, Spain
| | | | - Genoveva Yagüe
- Servicio de Microbiología, Hospital Virgen de la Arrixaca, Murcia, Spain
| | | | - Patricia Brañas
- Servicio de Microbiología, Hospital 12 de Octubre, Madrid, Spain
| | - Enrique Ruiz de Gopegui
- CIBER de Enfermedades Infecciosas (CIBERINFEC). Instituto Salud Carlos III, Madrid, Spain
- Servicio de Microbiología, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria Illes Balears (IdiSBA), Palma, Spain
| | | | - Federico García
- CIBER de Enfermedades Infecciosas (CIBERINFEC). Instituto Salud Carlos III, Madrid, Spain
- Servicio de Microbiología, Hospital San Cecilio, Instituto de Investigación IbS.GRANADA, Granada, Spain
| | - Emilia Cercenado
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital Universitario Gregorio Marañón, Madrid, Spain
- CIBER de Enfermedades Respiratorias (CIBERES). Instituto Salud Carlos III, Madrid, Spain
| | - Isabel Mellado
- Servicio de Pediatría y Enfermedades Infecciosas, Hospital Universitario La Paz, Fundación IdiPaz Madrid, Spain. Red de Investigación Traslación en Infectología Pediátrica (RITIP), Universidad Autónoma de Madrid, Madrid, Spain
| | - Elena Del Castillo
- Servicio de Pediatría. Hospital Materno Infantil de Badajoz, Badajoz, Spain
| | - María Pérez-Vazquez
- Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones Relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC). Instituto Salud Carlos III, Madrid, Spain
| | - Jesús Oteo-Iglesias
- Laboratorio de Referencia e Investigación en Resistencia a Antibióticos e Infecciones Relacionadas con la Asistencia Sanitaria, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC). Instituto Salud Carlos III, Madrid, Spain
| | - Cristina Calvo
- CIBER de Enfermedades Infecciosas (CIBERINFEC). Instituto Salud Carlos III, Madrid, Spain
- Servicio de Pediatría y Enfermedades Infecciosas, Hospital Universitario La Paz, Fundación IdiPaz Madrid, Spain. Red de Investigación Traslación en Infectología Pediátrica (RITIP), Universidad Autónoma de Madrid, Madrid, Spain
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Santos Martín MT, Ruiz Camacho M, Rodríguez García C, Álvarez Triano M, González Vila L. Streptococcus pyogenes as an etiological agent of acute epiglottitis. An Pediatr (Barc) 2023; 99:438-439. [PMID: 37949736 DOI: 10.1016/j.anpede.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 05/30/2023] [Indexed: 11/12/2023] Open
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Cobo-Vázquez E, Aguilera-Alonso D, Carbayo T, Figueroa-Ospina LM, Sanz-Santaeufemia F, Baquero-Artigao F, Vázquez-Ordoñez C, Carrasco-Colom J, Blázquez-Gamero D, Jiménez-Montero B, Grasa-Lozano C, Cilleruelo MJ, Álvarez A, Comín-Cabrera C, Penin M, Cercenado E, Del Valle R, Roa MÁ, Diego IGD, Calvo C, Saavedra-Lozano J. Epidemiology and clinical features of Streptococcus pyogenes bloodstream infections in children in Madrid, Spain. Eur J Pediatr 2023:10.1007/s00431-023-04967-5. [PMID: 37140702 DOI: 10.1007/s00431-023-04967-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/24/2023] [Accepted: 03/31/2023] [Indexed: 05/05/2023]
Abstract
Studies have shown increased invasive Group A Streptococcus (GAS) disease, including bloodstream infections (GAS-BSI). However, the epidemiological data of GAS-BSI are limited in children. We aimed to describe GAS-BSI in children in Madrid, over 13 years (2005-2017). Multicenter retrospective cohort study from 16 hospitals from Madrid, Spain. Epidemiology, symptomatology, laboratory, treatment, and outcome of GAS-BSI in children ≤ 16 years were analyzed. 109 cases of GAS-BSI were included, with incidence rate of 4.3 episodes/100,000 children attended at the emergency department/year. We compared incidence between two periods (P1: 2005-June 2011 vs P2: July 2011-2017) and observed a non-significant increase along the study period (annual percentage change: + 6.0% [95%CI: -2.7, + 15.4]; p = 0.163). Median age was 24.1 months (IQR: 14.0-53.7), peaking during the first four years of life (89/109 cases; 81.6%). Primary BSI (46.8%), skin and soft tissue (21.1%), and osteoarticular infections (18.3%) were the most common syndromes. We compared children with primary BSI with those with a known source and observed that the former had shorter hospital stay (7 vs. 13 days; p = 0.003) and received intravenous antibiotics less frequently (72.5% vs. 94.8%; p = 0.001) and for shorter duration of total antibiotic therapy (10 vs. 21 days; p = 0.001). 22% of cases required PICU admission. Factors associated with severity were respiratory distress, pneumonia, thrombocytopenia, and surgery, but in multivariate analysis, only respiratory distress remained significant (adjusted OR:9.23 [95%CI: 2.16-29.41]). Two children (1.8%) died. Conclusion: We observed an increasing, although non-significant, trend of GAS-BSI incidence within the study. Younger children were more frequently involved, and primary BSI was the most common and less severe syndrome. PICU admission was frequent, being respiratory distress the main risk factor. What is known: • In recent decades, several reports have shown a worldwide increase in the incidence of invasive Group A streptococcal disease (GAS), including bloodstream infection (BSI). Recently, there have been a few reports showing an increase in severity as well. • There needs to be more information on the epidemiology in children since most studies predominantly include adults. What is new: • This study, carried out in children with GAS-BSI in Madrid, shows that GAS-BSI affects mostly younger children, with a broad spectrum of manifestations, needing PICU admission frequently. Respiratory distress was the leading risk factor for severity, whereas primary BSI seemed to be less severe. • We observed an increasing, although non-significant, trend of GAS-BSI incidence in recent years (2005-2017).
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Affiliation(s)
- Elvira Cobo-Vázquez
- Department of Pediatrics, Hospital Universitario Fundación de Alcorcón, Servicio de Pediatría, Calle Budapest Nº1, 28922, Alcorcón, Madrid, Spain
- PhD Program in Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - David Aguilera-Alonso
- PhD Program in Medicine, Universidad Complutense de Madrid, Madrid, Spain.
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón. CIBER de enfermedades infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Servicio de Pediatría, Calle de O'Donnell, Madrid, 28009, Madrid, Spain.
| | - Tania Carbayo
- Department of Neonatology, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | | | | | - Fernando Baquero-Artigao
- Department of Infectious Diseases and Tropical Pediatrics, Hospital Universitario La Paz and IdiPaz Foundation, Madrid, Spain
- RITIP, Translational Research Network in Pediatric Infectious Diseases, CIBER de enfermedades infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Universidad Autónoma, Madrid, Spain
| | | | - Jaime Carrasco-Colom
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario La Moraleja, Madrid, Spain
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Daniel Blázquez-Gamero
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (imas12). Universidad Complutense, RITIP, Madrid, Spain
| | | | - Carlos Grasa-Lozano
- Department of Infectious Diseases and Tropical Pediatrics, Hospital Universitario La Paz and IdiPaz Foundation, Madrid, Spain
- RITIP, Translational Research Network in Pediatric Infectious Diseases, CIBER de enfermedades infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Universidad Autónoma, Madrid, Spain
- Department of Pediatrics, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - María José Cilleruelo
- Department of Pediatrics, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Ana Álvarez
- Department of Pediatrics, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - Cristina Comín-Cabrera
- Department of Pediatrics, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
| | - María Penin
- Department of Pediatrics, Hospital, Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Emilia Cercenado
- Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Rut Del Valle
- Department of Pediatrics, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Miguel Ángel Roa
- Department of Pediatrics, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain
| | | | - Cristina Calvo
- Department of Infectious Diseases and Tropical Pediatrics, Hospital Universitario La Paz and IdiPaz Foundation, Madrid, Spain
- RITIP, Translational Research Network in Pediatric Infectious Diseases, CIBER de enfermedades infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Universidad Autónoma, Madrid, Spain
| | - Jesús Saavedra-Lozano
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, CIBER de enfermedades infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Universidad Complutense, Madrid, Spain
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Asencio Egea MÁ, Gaitán Pitera J, Méndez González JC, Huertas Vaquero M. Utility of multiplex PCR syndromic panel for respiratory infections in the diagnosis of acute bacterial meningitis. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2021; 39:481-482. [PMID: 34475013 DOI: 10.1016/j.eimce.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/26/2020] [Indexed: 06/13/2023]
Affiliation(s)
- María Ángeles Asencio Egea
- Laboratorio de Microbiología, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain.
| | - Jorge Gaitán Pitera
- Laboratorio de Microbiología, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain
| | | | - María Huertas Vaquero
- Laboratorio de Microbiología, Hospital General La Mancha Centro, Alcázar de San Juan, Ciudad Real, Spain
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The Place of Group A Streptococci in Moroccan Children with Pharyngitis and Emm Type Distribution. ARCHIVES OF PEDIATRIC INFECTIOUS DISEASES 2021. [DOI: 10.5812/pedinfect.111172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Streptococcus pyogenes is responsible for a wide variety of diseases, including noninvasive and severe invasive infections. The emm gene encodes the M protein that is the virulence factor and immunological determinant of group A streptococci. Emm typing is the group A Streptococci (GAS) standard molecular typing method based on the amplification of the N terminal hypervariable region of the emm gene. Objectives: The aim of the present study was to determine the prevalence of GAS in children with pharyngitis and determine different types of emm gene in the GAS isolates using emm typing. Methods: The study was carried out over a period of 14 months (from February 2017 to March 2018). Throat samples were collected from cases aged ≤ 18 years with pharyngitis referring to a primary health care center in Fez, Morocco. GAS isolates were subjected to conventional tests to confirm species identification. Antimicrobial susceptibility testing was performed using the standard disk diffusion method. We researched emm gene by a polymerase chain reaction (PCR). Emm types were determined by a sequence-based protocol. Demographic and clinical data were recorded from each patient. Results: From a total of 177 throat samples, 11 isolates (6.2%) were identified as GAS in children with pharyngitis. Antibiotic sensitivity testing revealed that all the GAS isolates were sensitive to penicillin. The sequencing of the PCR products of the emm gene revealed that emm90 was the most obtained emm type (30,77%); while emm75 was the least type observed (7.7%). Conclusions: The emm90 is the most prevalent type detected from patients with tonsillitis. Penicillin and erythromycin are still the foremost effective antibiotics to treat GAS pharyngitis.
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Kebede D, Admas A, Mekonnen D. Prevalence and antibiotics susceptibility profiles of Streptococcus pyogenes among pediatric patients with acute pharyngitis at Felege Hiwot Comprehensive Specialized Hospital, Northwest Ethiopia. BMC Microbiol 2021; 21:135. [PMID: 33941090 PMCID: PMC8091706 DOI: 10.1186/s12866-021-02196-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 04/14/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Streptococcus pyogenes (S. pyogenes) is a Gram positive bacterium which is a leading cause of pharyngitis, skin and soft tissue infection and post streptococcal syndromes. Due to lack of β-lactamase enzyme production, it was considered universally susceptible to penicillin group and later generation of β-lactam antibiotics. As such, empirical treatment was common which might leads to development of antibiotics resistance. Therefore, the aims of this study were to determine the prevalence, antibiotics susceptibility profile; and associated factors of S. pyogenes among pediatric patients with acute pharyngitis in Felege Hiwot Comprehensive Specialized Hospital (FHCSH), Northwest Ethiopia. METHODS Hospital based cross-sectional study was carried out on 154 pediatric patients, whose age ranged from 0 to 18 years old using consecutive convenient sampling technique from 1st February to 19th June 2020 at FHCSH. S. pyogenes were identified by throat swab culture on 5% sheep blood agar with an overnight incubation at 37 °C in candle jar containing 5% CO2. Gram stain, catalase test and bacitracin test were used to identify S. pyogenes. Then,the data were entered into EpiData version 3.1 and analyzed by SPSS version 20 software. Finally, stepwise, bivariable and multivariable logistic regressions were carried out for identifyying factors having significant ssociation (p<0.05) with acute pharyngitis. RESULTS: From the total throat swabs, 14 (9.1%) with (95% CI; 4.5-14.3) were culture positive for S. pyogenes. From these, all isolates were sensitive to penicillin and ampicillin. On the otherhand, 4 (35.7%), 4 (35.5%), 3 (21.4%), 2 (14.3%), 1 (7.1%), 7 (50.0%) and 1 (7.1%) isolates were resistant for ceftriaxone, vancomycin, erythromycin, tetracycline, chloramphenicol, clindamycin and levofloxacin, respectively. The presence of any smoker in home showed significant association with S. pyogenes acute pharyngitis. Furthermore, having tender lymphadenopathy and recurrence were clinical predictors for S. pyogenes acute pharyngitis (P < 0.05). CONCLUSION The prevalence of S. pyogenes was guaged at 9.1% which is considered as low prevalence. All S. pyogenes isolats remain sensitive to penicillin. However, resistance was reported to clindamycin 7 (50.0%), ceftriaxone 5 (35.7%) and erythromycin 3 (21.4%). The current practice of giving erythromycin, clindamycin instead of penicillin and ampicillin is againest the microbiology result. Therefore, current empirical treatment of acute pharyngitis shall take in to account the current evidences. Continuous surveillance of antibiotics resistance pattern of S. pyogenes for acute pharyngitis must be strengthen to improve the use of antibiotics in hospitals.
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Affiliation(s)
- Destaw Kebede
- Shegaw Motta General Hospital, East Gojjam Zone, Motta Town, Ethiopia.
- Department of Medical laboratory Science, College of Medicine and Health Sciences, Bahir Dar University, P.O.Box: 79, Bahir Dar, Ethiopia.
| | - Alemale Admas
- Department of Medical laboratory Science, College of Medicine and Health Sciences, Bahir Dar University, P.O.Box: 79, Bahir Dar, Ethiopia
| | - Daniel Mekonnen
- Department of Medical laboratory Science, College of Medicine and Health Sciences, Bahir Dar University, P.O.Box: 79, Bahir Dar, Ethiopia
- Biotechnology Research Institute, Bahir Dar University, Bahir Dar, Ethiopia
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Piñeiro Pérez R, Álvez González F, Baquero-Artigao F, Cruz Cañete M, de la Flor i Bru J, Fernández Landaluce A, García Vera C, Hijano Bandera F, Pérez Cánovas C, Silva Rico JC, Alfayate Miguélez S, Ares Álvarez J, Berghezan Suárez A, Borrull Senra AM, Cabrera Roca G, Calvo Rey C, Carazo Gallego B, Cilleruelo Ortega MJ, Conejo Fernández A, López Ávila J, Lupiani Castellanos P, Martínez Campos L, Sotoca Fernández J. Actualización del documento de consenso sobre el diagnóstico y tratamiento de la faringoamigdalitis aguda. An Pediatr (Barc) 2020; 93:206.e1-206.e8. [DOI: 10.1016/j.anpedi.2020.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/05/2020] [Accepted: 05/12/2020] [Indexed: 10/24/2022] Open
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Diagnosis and treatment of acute tonsillopharyngitis. Consensus document update. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.anpede.2020.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Evaluation of a rapid diagnostic test for the detection of Streptococcus pyogenes in invasive infections. Rev Argent Microbiol 2020; 52:261-265. [PMID: 31926748 DOI: 10.1016/j.ram.2019.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 07/12/2019] [Accepted: 08/08/2019] [Indexed: 11/21/2022] Open
Abstract
Invasive Streptococcus pyogenes diseases represent the most severe form of infection produced by this microorganism. Early diagnosis and treatment are important, due to its potential severity. Etiological confirmation of invasive infection is performed by culture, which takes between 18 and 48h. We tested a rapid immunochromatographic assay directly from clinical samples from normally sterile sites and positive blood culture bottles when positive cocci chains were observed by Gram staining. Eighty samples were analyzed. The rapid test was positive in 35 samples: in 34 of them S. pyogenes was confirmed by culture. The immunochromatographic method showed 97.1% sensitivity and 97.8% specificity. The strept A® immunochromatographic rapid test allows to obtain reliable results in less than 10min and is accessible to any microbiology laboratory. This study demonstrates the potential use of a rapid immunochromatographic method directly from clinical samples and positive blood cultures.
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Molecular Characterization of Streptococcus pyogenes Causing Invasive Disease in Pediatric Population in Spain A 12-year Study. Pediatr Infect Dis J 2019; 38:1168-1172. [PMID: 31738331 DOI: 10.1097/inf.0000000000002471] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To perform a comprehensive description of the epidemiology of Streptococcus pyogenes invasive disease in the pediatric population in 2 regions of Spain (Catalonia and Gipuzkoa) through 12 years. METHODS All S. pyogenes isolates causing invasive disease in pediatric patients between 2005 and 2016 were included. The emm-type and the presence of 13 exotoxin genes (speA, speB, speC, speF, speG, speH, speI, speJ, speK, speL, speM, smeZ, ssa and slo) were determined in all 93 available isolates and the Multi Locus Sequece Typing in 10% of isolates of each different emm-type. RESULTS Overall, 103 cases of S. pyogenes invasive infections were detected: 77 in Catalonia and 26 in Gipuzkoa, being 50.5% females. The incidence rate per 100,000 children was 2.5 for Gipuzkoa and 2.6 for Catalonia, with no significant temporal trends. The median age was 30 months. The most frequent clinical presentations were: pneumonia (26.2%), bacteremia/sepsis (23.3%), septic arthritis/osteomyelitis (22.3%), cellulitis/mastoiditis (12.6%) and meningitis (6.8%). Eight children developed streptococcal toxic shock syndrome. Nine cases were preceded by varicella infection. The associated mortality rate was 3.9%. Three isolates were resistant to erythromycin, being one of them also resistant to clindamycin and 4 isolates were resistant to levofloxacine. Forteen different emm-types were detected being emm1/ST28 (40.9%) the most frequent clone in both regions followed by emm12/ST36-ST242, emm6/ST382, emm3/ST15, emm75/ST150 and emm4/ST38-39. speA gene was only detected in emm1 and emm3 isolates. Eight exotoxins were enough to assign an emm-type with a very high degree of accuracy (95%). The 30-valent vaccine would include 96.8% of isolates.
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Invasive disease due to Streptococcus pyogenes: Changes in incidence and prognostic factors. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.anpede.2018.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Suárez-Arrabal MC, Sánchez Cámara LA, Navarro Gómez ML, Santos Sebastián MDM, Hernández-Sampelayo T, Cercenado Mansilla E, Saavedra-Lozano J. [Invasive disease due to Streptococcus pyogenes: Changes in incidence and prognostic factors]. An Pediatr (Barc) 2019; 91:286-295. [PMID: 30837112 DOI: 10.1016/j.anpedi.2018.12.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 12/16/2018] [Accepted: 12/17/2018] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Invasive group A streptococcal disease (iGASD) is a serious infection in children. Several studies have shown an increased incidence in the past years. OBJECTIVE To evaluate the characteristics and outcome of iGASD in children, and to determine changes in incidence or severity. MATERIAL AND METHODS A retrospective study was conducted on children≤16 years evaluated in a tertiary paediatric hospital in Madrid, and diagnosed with iGASD (June 2005-July 2013). An analysis was made of the demographics, symptomatology, microbiology, and treatment. The changes throughout the period studied were evaluated, as well as parameters associated with disease severity. RESULTS The study included a total of 55 children with iGASD, with 33 (60%) females, and a median age of 48.5 (20.5-88.9) months. The most frequent clinical syndromes were cellulitis/subcutaneous abscess (21.8%), ENT abscess (20%), pneumonia (16.4%), osteoarticular infection (16.4%), and mastoiditis (12.7%). The incidence of iGASD (cases/105 emergencies/year) increased from 5.6 (4.2-7.2) between June 2005-May 2009 to 18.9 (15.1-26) between June 2009-May 2013; P=.057. Surgery and admission to PICU was required by 35 (63.6%) and 10 (18.2%) patients, respectively. Children in PICU were younger (26.5 vs 52.6 months, P=.116), had a higher C-reactive protein (24.5 vs 10.7mg/dl, P<.001) and higher frequency of pneumonia (60 vs 7%, P<.001). In the multivariate analysis, only C-reactive protein was a risk factor for admission to PICU (OR: 1.14 [1.004-1.286], P=.04). There were no sequelae. CONCLUSIONS An increased incidence of iGASD was observed in the children in this study. Lower age, pneumonia, and higher C-reactive protein were associated with disease severity in this series.
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Affiliation(s)
- María Carmen Suárez-Arrabal
- Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España.
| | - Luis Alberto Sánchez Cámara
- Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - María Luisa Navarro Gómez
- Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España; Universidad Complutense de Madrid, Madrid, España
| | - María Del Mar Santos Sebastián
- Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Teresa Hernández-Sampelayo
- Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España; Universidad Complutense de Madrid, Madrid, España
| | - Emilia Cercenado Mansilla
- Universidad Complutense de Madrid, Madrid, España; Servicio de Microbiología y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Jesús Saavedra-Lozano
- Sección de Enfermedades Infecciosas, Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Madrid, España; Universidad Complutense de Madrid, Madrid, España
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