Characteristics of mucoid Streptococcus pyogenes isolated from two patients with pneumonia in a local community

Early surgery for limb preservation in Group A Streptococcus-induced necrotizing soft tissue infection and subsequent soft tissue infection: A case report

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This is a case of necrotizing soft tissue infection (NSTI) due to S. pyogenes.

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Exploration and subsequent debridement led to the limb preservation.

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Early surgery is crucial for effective treatment of NSTI.

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Non-necrotizing STI due to S. pyogenes could be possible to reccure at the same limb 2 months later.

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The patient received antimicrobial treatment without surgery and recovered.

Background

Group A Streptococcus pyogenes (GAS) causes necrotizing soft tissue infections (NSTIs) necessitating exploration, surgical debridement, and possibly limb amputation.

Case presentation

A 45-year-old man presented with traumatic injury of the left carpal region, vomiting, and diarrhea. The swelling and pain in the left forearm worsened with sensorimotor deficits, and his skin color deteriorated. Emergent exploration was performed for limb preservation; GAS was detected in an exudate, and debridement was performed on postoperative day 2 for streptococcal toxic shock syndrome. He recovered uneventfully and was discharged; however, he returned after 2 months with GAS-induced STI at the same site and received antimicrobial treatment.

Conclusion

Exploration and subsequent debridement are crucial for effective treatment of NSTI.

Severe community-acquired pneumonia due to Streptococcus pyogenes in the Newcastle area

Background

An apparent increase in the incidence of severe community-acquired pneumonia (CAP) caused by Streptococcus pyogenes (group A Streptococcus - GAS) was observed during 2017 in the Newcastle area. The study was undertaken to establish whether there was a true increase in severe S. pyogenes pneumonia and to explore its epidemiology and clinical features.

Methods

The study was a retrospective descriptive study of S. pyogenes pneumonia set in two tertiary referral hospitals in Newcastle, a large regional city, during the period 2007 to 2018. Subjects were adults identified as having S. pyogenes pneumonia by searching a database of severe CAP (defined as requiring intensive care unit [ICU] admission) for the period 2007-2018. Laboratory records were also searched for sterile site isolates of S. pyogenes to identify patients not requiring ICU admission.

Results

There were 13 cases of S. pyogenes CAP identified during the study period, of whom 12 (92%) required ICU admission. S. pyogenes accounted for 12/728 (1.6%) cases of severe CAP during the study period. The severity of S. pyogenes pneumonia was high despite a mean patient age of 48 years and 7/13 (54%) having no significant past medical history. The mortality rate was 2/13 (15%). Viral co-infection was found in 6/12 (50%) of patients tested. Overall 7/12 (58%) of the patients with severe S. pyogenes CAP during the study period presented in the winter or spring of 2017.

Conclusions

Streptococcus pyogenes is a rare cause of severe CAP in the Newcastle area, but there was a marked increase in frequency observed during the 2017 influenza season. Further study of the epidemiology of invasive GAS (iGAS) disease in Newcastle is warranted to identify emerging trends in this severe infection.

Increase in Invasive Group A Streptococcal Disease and Emergence of Mucoid Strains in a Pediatric Population: February-June 2017

Background

Infection with group A Streptococcus (GAS) can cause severe systemic and locally invasive disease. Invasive group A streptococcal (iGAS) disease incidence varies both seasonally and year-to-year, and it may exhibit clustered outbreaks. We observed an upswing in iGAS cases at a tertiary care Children’s Hospital, prompting further characterization of local iGAS disease.

Methods

Cases of iGAS disease were abstracted from the medical record by manual chart review of all positive screening tests and cultures for GAS over a 4-year span. Incidence rates per 1000 hospital admissions and per 100 positive GAS tests were calculated and compared. Selected isolates were further characterized by whole-genome sequencing.

Results

Significant year-to-year differences in per-admission iGAS incidence rate were observed in February and June, although per-positive test incidence rates were not significantly different. Whole-genome sequencing revealed 2 dominant serotypes—emm3 and emm6—with high rates of mucoid phenotype and systemic bacteremia.

Conclusions

We document a significant but transient increase in iGAS disease incidence in 2 months of 2017. Genome sequencing revealed 2 dominant serotypes associated with mucoid phenotypes and severe disease, highlighting the dynamic nature of iGAS disease pattern.

Pleural empyema and streptococcal toxic shock syndrome due to Streptococcus pyogenes in a healthy Spanish traveler in Japan

Group A Streptococcus (GAS, Streptococcus pyogenes) causes invasive infections including streptococcal toxic shock syndrome (STSS) and local infections. To our knowledge, this is the first report of a case of an invasive GAS infection with pneumonia and pleural empyema (PE) followed by STSS (disseminated intravascular coagulation [DIC] and acute renal insufficiency) in a healthy male adult. He received combined supportive therapies of PE drainage, anti-DIC agent, hemodialysis, and antimicrobials and eventually made a clinical recovery. GAS isolated from PE was found to have emm1/speA genes, suggestive of a pathogenic strain. Clinicians should be aware of the possibility of this disease entity (pneumonia, PE, and STSS) in healthy male adults as well as children and adult women.