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Phakey S, Campbell PT, Gibney KB. Epidemiology of scarlet fever in Victoria, Australia, 2007-2017. Epidemiol Infect 2024; 152:e116. [PMID: 39363595 PMCID: PMC11450502 DOI: 10.1017/s0950268824001298] [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: 03/08/2024] [Revised: 06/24/2024] [Accepted: 08/08/2024] [Indexed: 10/05/2024] Open
Abstract
In the last 10-15 years, there has been a global resurgence of scarlet fever, an infection historically associated with significant morbidity and mortality. It is unknown whether scarlet fever incidence has increased in Australia. We aimed to examine the incidence, predictors and severity of scarlet fever in the state of Victoria, Australia from 2007 to 2017, analyzing scarlet fever emergency department (ED) presentations, hospitalizations and deaths. Of the 1 578 scarlet fever cases during the study period, most occurred in children aged <10 years (1 344, 85%), in males (882, 56%), and during winter and spring months (918, 57%). There were no deaths with scarlet fever, however, 374 cases (24%) were admitted to hospital. The annual incidence of scarlet fever was stable during the study period (mean, 2.5; range, 1.9-3.1 cases per 100 000). Annual incidence was highest in children aged <5 years (19.3 per 100 000), and was 21% higher in males than females, adjusting for age and year (incidence rate ratio, 1.21, 95%CI 1.09-1.34). Whilst scarlet fever ED presentations and hospitalizations were stable in Victoria from 2007 to 2017, the recent identification of a Streptococcus pyogenes variant in Australia associated with epidemic scarlet fever overseas highlights the risk of future outbreaks.
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Affiliation(s)
- Sachin Phakey
- The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Patricia T. Campbell
- Department of Infectious Diseases, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Katherine B. Gibney
- The Royal Melbourne Hospital, Melbourne, VIC, Australia
- Department of Infectious Diseases, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
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Schöbi N, Duppenthaler A, Horn M, Bartenstein A, Keitel K, Kopp MV, Agyeman PKA, Aebi C. Ongoing Excess Hospitalizations for Severe Pediatric Group A Streptococcal Disease in 2023-2024-A Single-Center Report. Infect Dis Rep 2024; 16:864-869. [PMID: 39311208 PMCID: PMC11417816 DOI: 10.3390/idr16050067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Revised: 08/27/2024] [Accepted: 08/29/2024] [Indexed: 09/26/2024] Open
Abstract
A Europe-wide outbreak of invasive pediatric group A streptococcal infections (iGAS) began in fall 2022. Here, we report the evolution of GAS hospitalizations in children and adolescents during the second outbreak year in 2023-2024 at a tertiary center in Switzerland. Using prospective monitoring of all in-patient GAS cases below 16 years of age, including those with iGAS, we compared case frequencies and clinical characteristics in three time periods (2013-2020; 2022-2023; 2023-2024). Annual GAS hospitalizations increased from a median of 25 cases (range 11-28) in 2013-2020 to 89 and 63 cases, respectively, in 2022-2023 and 2023-2024. iGAS cases evolved similarly (2013-2020, 4 cases (3-8); 2022-2023, 32 cases; 2023-2024, 21 cases). The decline in cases from 2022-2023 to 2023-2024 included all types of GAS organ involvement, except suppurative infections in the head area, which remained largely unchanged (48 vs. 45 cases). Pleural empyema declined from 13 to 7 cases, possibly explained by a poor overlap of the GAS and influenza curves, respectively, in 2023-2024 compared to 2022-2023. These data document the prolongation of the GAS outbreak into its second winter season in 2023-2024.
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Affiliation(s)
- Nina Schöbi
- Division of Pediatric Infectious Disease, Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, CH-3010 Bern, Switzerland; (N.S.); (A.D.); (M.H.); (M.V.K.); (P.K.A.A.)
| | - Andrea Duppenthaler
- Division of Pediatric Infectious Disease, Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, CH-3010 Bern, Switzerland; (N.S.); (A.D.); (M.H.); (M.V.K.); (P.K.A.A.)
| | - Matthias Horn
- Division of Pediatric Infectious Disease, Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, CH-3010 Bern, Switzerland; (N.S.); (A.D.); (M.H.); (M.V.K.); (P.K.A.A.)
| | - Andreas Bartenstein
- Department of Pediatric Surgery, Bern University Hospital, Inselspital, University of Bern, CH-3010 Bern, Switzerland;
| | - Kristina Keitel
- Pediatric Emergency Center, Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, CH-3010 Bern, Switzerland;
| | - Matthias V. Kopp
- Division of Pediatric Infectious Disease, Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, CH-3010 Bern, Switzerland; (N.S.); (A.D.); (M.H.); (M.V.K.); (P.K.A.A.)
- Airway Research Center North (ARCN), University of Lübeck, D-23562 Lübeck, Germany
| | - Philipp K. A. Agyeman
- Division of Pediatric Infectious Disease, Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, CH-3010 Bern, Switzerland; (N.S.); (A.D.); (M.H.); (M.V.K.); (P.K.A.A.)
| | - Christoph Aebi
- Division of Pediatric Infectious Disease, Department of Pediatrics, Bern University Hospital, Inselspital, University of Bern, CH-3010 Bern, Switzerland; (N.S.); (A.D.); (M.H.); (M.V.K.); (P.K.A.A.)
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Dou ZZ, Li W, Hu HL, Guo X, Hu B, Chen TM, Chen HY, Guo LY, Liu G. Group A Streptococcal meningitis in children: a short case series and systematic review. Eur J Clin Microbiol Infect Dis 2024; 43:1517-1531. [PMID: 38842766 PMCID: PMC11271352 DOI: 10.1007/s10096-024-04863-2] [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: 03/19/2024] [Accepted: 05/24/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Group A streptococcal(GAS) meningitis is a severe disease with a high case fatality rate. In the era of increasing GAS meningitis, our understanding about this disease is limited. PURPOSE To gain a better understanding about GAS meningitis. METHODS Five new cases with GAS meningitis were reported. GAS meningitis related literatures were searched for systematic review in PUBMED and EMBASE. Case reports and case series on paediatric cases were included. Information on demographics, risk factors, symptoms, treatments, outcomes, and emm types of GAS was summarized. RESULTS Totally 263 cases were included. Among 100 individuals, 9.9% (8/81) had prior varicella, 11.1% (9/81) had anatomical factors, and 53.2% (42/79) had extracranial infections. Soft tissue infections were common among infants (10/29, 34.5%), while ear/sinus infections were more prevalent in children ≥ 3 years (21/42, 50.0%). The overall case fatality rate (CFR) was 16.2% (12/74). High risk of death was found in patients with shock or systemic complications, young children(< 3 years) and cases related to hematogenic spread. The predominate cause of death was shock(6/8). Among the 163 patients included in case series studies, ear/sinus infections ranged from 21.4 to 62.5%, while STSS/shock ranged from 12.5 to 35.7%, and the CFR ranged from 5.9 to 42.9%. CONCLUSIONS A history of varicella, soft tissue infections, parameningeal infections and CSF leaks are important clinical clues to GAS in children with meningitis. Young children and hematogenic spread related cases need to be closely monitored for shock due to the high risk of death.
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Affiliation(s)
- Zhen-Zhen Dou
- Department of Infectious Diseases, Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Ministry of Education, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
- Research Unit of Critical infection in Children, Chinese Academy of Medical Sciences, Beijing, 2019RU016, China
| | - Wanrong Li
- Department of Infectious Diseases, Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Ministry of Education, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
- Research Unit of Critical infection in Children, Chinese Academy of Medical Sciences, Beijing, 2019RU016, China
| | - Hui-Li Hu
- Department of Infectious Diseases, Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Ministry of Education, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
- Research Unit of Critical infection in Children, Chinese Academy of Medical Sciences, Beijing, 2019RU016, China
| | - Xin Guo
- Department of Infectious Diseases, Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Ministry of Education, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
- Research Unit of Critical infection in Children, Chinese Academy of Medical Sciences, Beijing, 2019RU016, China
| | - Bing Hu
- Department of Infectious Diseases, Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Ministry of Education, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
- Research Unit of Critical infection in Children, Chinese Academy of Medical Sciences, Beijing, 2019RU016, China
| | - Tian-Ming Chen
- Department of Infectious Diseases, Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Ministry of Education, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
- Research Unit of Critical infection in Children, Chinese Academy of Medical Sciences, Beijing, 2019RU016, China
| | - He-Ying Chen
- Department of Infectious Diseases, Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Ministry of Education, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
- Research Unit of Critical infection in Children, Chinese Academy of Medical Sciences, Beijing, 2019RU016, China
| | - Ling-Yun Guo
- Department of Infectious Diseases, Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Ministry of Education, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
- Research Unit of Critical infection in Children, Chinese Academy of Medical Sciences, Beijing, 2019RU016, China
| | - Gang Liu
- Department of Infectious Diseases, Key Laboratory of Major Diseases in Children, Beijing Children's Hospital, Ministry of Education, Capital Medical University, National Center for Children's Health, Beijing, 100045, China.
- Research Unit of Critical infection in Children, Chinese Academy of Medical Sciences, Beijing, 2019RU016, China.
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Di Pietro GM, Marchisio P, Bosi P, Castellazzi ML, Lemieux P. Group A Streptococcal Infections in Pediatric Age: Updates about a Re-Emerging Pathogen. Pathogens 2024; 13:350. [PMID: 38787202 PMCID: PMC11124454 DOI: 10.3390/pathogens13050350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 05/25/2024] Open
Abstract
Group A Streptococcus (GAS) presents a significant global health burden due to its diverse clinical manifestations ranging from mild infections to life-threatening invasive diseases. While historically stable, the incidence of GAS infections declined during the COVID-19 pandemic but resurged following the relaxation of preventive measures. Despite general responsiveness to β-lactam antibiotics, there remains an urgent need for a GAS vaccine due to its substantial global disease burden, particularly in low-resource settings. Vaccine development faces numerous challenges, including the extensive strain diversity, the lack of suitable animal models for testing, potential autoimmune complications, and the need for global distribution, while addressing socioeconomic disparities in vaccine access. Several vaccine candidates are in various stages of development, offering hope for effective prevention strategies in the future.
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Affiliation(s)
- Giada Maria Di Pietro
- Pediatric Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Paola Marchisio
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy (P.L.)
| | - Pietro Bosi
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy (P.L.)
| | - Massimo Luca Castellazzi
- Pediatric Emergency Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Paul Lemieux
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122 Milan, Italy (P.L.)
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Okai N, Otsuka Y, Masaki S, Kudo M, Watanabe T. Necrotizing Fasciitis of the Serratus Anterior in a Patient Treated With Infliximab and Prednisolone for Ulcerative Colitis and Rheumatoid Arthritis. Cureus 2024; 16:e59346. [PMID: 38817521 PMCID: PMC11137776 DOI: 10.7759/cureus.59346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 06/01/2024] Open
Abstract
Necrotizing fasciitis (NF) is a rapidly progressive bacterial infection with high mortality. Invasive group A Streptococcus (GAS) infection is the leading cause of NF. Our understanding regarding clinicopathological features and pathogenesis of invasive GAS infection is expanding as the incidence of NF in healthy individuals increases. However, clinicopathological features of NF in the presence of autoimmune diseases have been poorly defined. We experienced NF in a patient treated with infliximab and prednisolone for ulcerative colitis and rheumatoid arthritis. Herein, we present time kinetics findings of clinical symptoms and laboratory data of GAS-associated NF in the presence of immunosuppressant-treated immune disorders.
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Affiliation(s)
- Natsuki Okai
- Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, JPN
| | - Yasuo Otsuka
- Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, JPN
| | - Sho Masaki
- Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, JPN
| | - Masatoshi Kudo
- Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, JPN
| | - Tomohiro Watanabe
- Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Osaka-Sayama, JPN
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6
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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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7
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Hung TY, Phuong LK, Grobler A, Tong SYC, Freeth P, Pelenda A, Gibney KB, Steer AC. Antibiotics to eradicate Streptococcus pyogenes pharyngeal carriage in asymptomatic children and adults: A systematic review. J Infect 2024; 88:106104. [PMID: 38360357 DOI: 10.1016/j.jinf.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 01/14/2024] [Indexed: 02/17/2024]
Abstract
Streptococcus pyogenes (S. pyogenes) is a Gram-positive bacteria which causes a spectrum of diseases ranging from asymptomatic infection to life-threatening sepsis. Studies report up to 2000 times greater risk of invasive S. pyogenes disease in close contacts of index cases within 30-days of symptom onset. Despite this, there is variability in the management of asymptomatic carriage of S. pyogenes and those at risk of secondary cases of invasive S. pyogenes infection. OBJECTIVE Our systematic review assessed the efficacy of different antibiotic regimens used for eradication of S. pyogenes from the pharynx in asymptomatic individuals. METHODS We searched Pubmed, EMBASE (1974-), OVID Medline (1948-) and the Cochrane CENTRAL registry. We included randomised controlled trials (RCTs) with asymptomatic participants with >50% with pharyngeal cultures positive with S. pyogenes at baseline. Only studies with microbiological methods including culture (+/- polymerase chain reaction, PCR) were included. We included studies published in English. Each included study was assessed by two independent reviewers for data extraction and risk of bias. RESULTS Of 1166 unique records identified, three RCTs were included in the review. Two of the three included RCTs found oral clindamycin for 10-days was the most efficacious regimen, compared to intramuscular benzathine penicillin G followed by 4 days of oral rifampicin, or monotherapy using benzathine penicillin, phenoxymethylpenicillin or erythromycin. Two RCTs were assessed as being at high risk of bias, with the third study demonstrating low/some risk of bias. CONCLUSIONS Current available evidence for the optimal antibiotic in eradicating pharyngeal S. pyogenes carriage is limited. Future RCTs should include penicillin, first-generation cephalosporins, rifampicin, macrolides (such as azithromycin) and clindamycin.
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Affiliation(s)
- Te-Yu Hung
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; Department of Paediatrics, Royal Darwin Hospital, Top End Health Service, Northern Territory, Australia.
| | - Linny K Phuong
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia; Tropical Diseases, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Anneke Grobler
- Tropical Diseases, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Steven Y C Tong
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Pippin Freeth
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Asika Pelenda
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Katherine B Gibney
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.
| | - Andrew C Steer
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia; Tropical Diseases, Murdoch Children's Research Institute, Parkville, Victoria, Australia
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