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Hasegawa J, Sekizawa A, Tanaka H, Katsuragi S, Tanaka K, Nakata M, Hayata E, Murakoshi T, Ishiwata I, Ikeda T. Infection route associated with invasive group A streptococcal toxic shock syndrome in maternal deaths: Nationwide analysis of maternal mortalities in Japan. Int J Infect Dis 2024; 146:107154. [PMID: 38936654 DOI: 10.1016/j.ijid.2024.107154] [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: 05/08/2024] [Revised: 06/20/2024] [Accepted: 06/22/2024] [Indexed: 06/29/2024] Open
Abstract
OBJECTIVES To clarify the infection route in maternal death due to invasive group A streptococcal (GAS) infection and toxic shock syndrome (TSS). METHODS A retrospective study was conducted on maternal deaths due to GAS-TSS in Japan between January 2010 and March 2024. The final causal diagnosis of maternal death and the infection routes of GAS were analysed using medical records, laboratory data and autopsy findings. RESULTS Among the 616 maternal deaths during the study period, 48 (8%) involved infectious diseases. The most common infection was invasive GAS (56%, n = 27), 21 (78%) and six cases occurred during the antepartum and puerperium periods, respectively. In the GAS-TSS group, 71% (15/21) infections were originated the upper respiratory tract. However, in the puerperium cases, 67% (4/6) were infected from the genital tract. In addition, no maternal deaths due to GAS-TSS were reported during the COVID-19 pandemic period in Japan from 2020 to 2023. CONCLUSION Most antepartum GAS infections were from the upper respiratory tract. They may be reduced by preventive measures, including frequent disinfection, wearing masks and isolation from persons at high risk of carrying GAS, such as symptomatic children. On the other hand, GAS-TSS during puerperium infection via the genital tract.
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Affiliation(s)
- Junichi Hasegawa
- Department of Perinatal Developmental Pathophysiology, St. Marianna University Graduate School of Medicine, Kawasaki, Japan.
| | - Akihiko Sekizawa
- Department of Obstetrics and Gynecology, Showa University School of Medicine, Tokyo, Japan
| | - Hiroaki Tanaka
- Department of Obstetrics and Gynecology, Kumamoto General Hospital, Kumamoto, Japan
| | - Shinji Katsuragi
- Department of Obstetrics and Gynaecology, Miyazaki University School of Medicine, Miyazaki, Japan
| | - Kayo Tanaka
- Department of Obstetrics and Gynecology, Kumamoto General Hospital, Kumamoto, Japan
| | - Masahiko Nakata
- Department of Obstetrics and Gynecology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Eijiro Hayata
- Department of Obstetrics and Gynecology, Toho University Faculty of Medicine, Tokyo, Japan
| | - Takeshi Murakoshi
- Division of Perinatology, Maternal and Perinatal Care Center, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Isamu Ishiwata
- Ishiwata Obstetrics and Gynecology Hospital, Ibaraki, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University School of Medicine, Mie, Japan
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Inada M, Iwamoto N, Nomoto H, Tsuzuki S, Takemoto N, Fuwa N, Moriya A, Ohmagari N. Characteristics of Streptococcal Toxic Shock Syndrome Caused by Different Beta-hemolytic Streptococci Species: A Single-center Retrospective Study. Open Forum Infect Dis 2024; 11:ofae486. [PMID: 39296344 PMCID: PMC11409875 DOI: 10.1093/ofid/ofae486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 08/26/2024] [Indexed: 09/21/2024] Open
Abstract
Background Streptococcal toxic shock syndrome (STSS) is a life-threatening condition caused by beta-hemolytic streptococci (BHS). Streptococcus pyogenes is the main causative agent of this disease; other BHS such as Streptococcus agalactiae or Streptococcus dysgalactiae could also cause STSS. However, the clinical characteristics of STSS caused by other types of BHS remain poorly understood. In this study, we evaluated the likelihood of STSS development in various streptococcal species. Methods We conducted a retrospective observational study using adult medical records of patients with invasive BHS in a tertiary care institution from 2002 to 2022 and classified them into STSS or non-STSS groups. Multivariable analysis of bacterial species adjusted for age and diabetes mellitus was conducted. S pyogenes cases were propensity-matched (1:4) to non-pyogenes BHS cases. Results A total of 43 STSS and 285 non-STSS cases were identified. S pyogenes, S agalactiae, and S dysgalactiae accounted for 17, 13, and 13 STSS cases, respectively. The crude mortality of STSS was approximately 35% in all groups. A multivariable analysis suggested that STSS was less frequent in S agalactiae and S dysgalactiae cases with odds ratio 0.24 (95% confidence interval [CI], 0.10-0.54; P < .001) and 0.23 (95% CI, .10-.55; P < .001), respectively. Propensity score matching showed that S pyogenes caused STSS more frequently than other BHS cases with an odds ratio of 3.28 (95% CI 1.21-8.77; P = .010). Conclusions This study described and compared the clinical characteristics of STSS caused by different BHS. We demonstrated that S pyogenes caused STSS more often than other BHS.
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Affiliation(s)
- Makoto Inada
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Noriko Iwamoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hidetoshi Nomoto
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Shinya Tsuzuki
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norihiko Takemoto
- Department of Infectious Diseases, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Noriko Fuwa
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Ataru Moriya
- Laboratory Testing Department, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
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Ladomenou F, Kosmeri C, Siomou E. Host Defense Susceptibility and Invasive Streptococcal Infections. Pediatr Infect Dis J 2024; 43:e314-e317. [PMID: 38985996 DOI: 10.1097/inf.0000000000004446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2024]
Affiliation(s)
- Fani Ladomenou
- From the Department of Pediatrics, University Hospital of Ioannina, Ioannina, Greece
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Song M, Huang X, Hou Y, Yang F, Li X, Li J. Perinatal group A streptococcal infection in vagina and its impact on pregnancy outcomes. Am J Transl Res 2024; 16:1806-1814. [PMID: 38883355 PMCID: PMC11170569 DOI: 10.62347/zkie2772] [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: 12/31/2023] [Accepted: 03/11/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE To investigate the prevalence, antimicrobial susceptibility, and the effects on pregnancy and neonatal outcomes of Group A Streptococcal (GAS) infections in the vagina of perinatal women. METHODS From June 2020 to October 2022, 270 perinatal pregnant women underwent vaginal swabs for GAS culture. The antibiotic sensitivity of the positive strains was assessed. Based on GAS detection results, the patients were divided into an observation group (GAS positive) and a control group (GAS negative). Clinical data from both groups were collected to compare the vaginal microecological changes. The adverse outcomes for pregnancy and infants in both groups were retrospectively analyzed. Univariate and multivariate analyses were used to identify the risk factors for adverse outcomes. RESULTS Among the 270 pregnant women, 30 tested positive for GAS and 240 tested negative, with a colonization rate of 11.1%. No resistance to penicillin, ampicillin, linezolid, vancomycin, or tigecycline was found among the GAS strains. The resistance rates to tetracycline and clindamycin were 73.3% and 70.0%, respectively. Higher vaginal pH (≥4.5), and increased incidences of bacterial vaginitis, aerobic vaginitis, and microecological imbalances were observed in the observation group compared to the control group (all P<0.05). The observation group also experienced more adverse pregnancy and infant outcomes, such as chorioamnionitis, postpartum infections, fetal distress, and neonatal pneumonia (all P<0.05). Univariate and multivariate analyses indicated that a vaginal pH≥4.5 and microecological imbalance were positively associated with poor maternal and infant outcomes in women with GAS infections (all P<0.05). CONCLUSIONS The study found no β-lactam resistant GAS strains. Additionally, a higher vaginal pH (≥4.5) and microecological imbalance were linked to an increased risk of adverse pregnancy and infant outcomes in women with GAS infections.
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Affiliation(s)
- Min Song
- Department of Obstetrics and Gynecology, Jinan Maternal and Child Health Hospital Affiliated to Shandong First Medical University Jinan, Shandong, China
| | - Xiaoge Huang
- Department of Obstetrics and Gynecology, Jinan Maternal and Child Health Hospital Affiliated to Shandong First Medical University Jinan, Shandong, China
| | - Yanmei Hou
- Department of Obstetrics and Gynecology, Jinan Maternal and Child Health Hospital Affiliated to Shandong First Medical University Jinan, Shandong, China
| | - Fang Yang
- Department of Obstetrics and Gynecology, Jinan Maternal and Child Health Hospital Affiliated to Shandong First Medical University Jinan, Shandong, China
| | - Xiaoping Li
- Department of Obstetrics and Gynecology, Jinan Maternal and Child Health Hospital Affiliated to Shandong First Medical University Jinan, Shandong, China
| | - Juan Li
- Department of Pathology, Jinan Maternal and Child Health Hospital Affiliated to Shandong First Medical University Jinan, Shandong, China
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Jardim J, Araújo S, Andrade T, Caldeira T, Soares P. Group A Streptococcal Toxic Shock Syndrome With Portal Vein Thrombosis: A Rare Presentation in Newborns. Cureus 2024; 16:e58520. [PMID: 38957821 PMCID: PMC11218550 DOI: 10.7759/cureus.58520] [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: 04/17/2024] [Indexed: 07/04/2024] Open
Abstract
Invasive disease due to group A Streptococcus infection results in a large spectrum of clinical manifestations. In the neonatal period, the occurrence is rare and potentially serious. We present a case of a term male newborn on the 9th day of life who was admitted to the emergency room with moaning and poor feeding. The patient was hemodynamically unstable needing mechanical ventilation and inotropic support. Mother and father had clinical symptoms of pharyngitis. Blood samples revealed high serum C-reactive protein and procalcitonin, leucopenia, thrombocytopenia, hyponatremia, hepatic cytolysis, and cholestasis. He started on IV ampicillin, gentamicin, and cefotaxime. Due to an abdominal distension, an ultrasound was done showing a heterogenous hepatic lobe. A color Doppler scan completed the study revealing a left hepatic thrombosis. Enoxaparin was started. The newborn's blood culture and mother's milk were positive for the same strain of group A Streptococcus. Intravenous immunoglobulin and clindamycin were added to the treatment. On day 5 of treatment, inotropic support was ceased and extubation took place on day 6. Neonatologists should be aware of rare complications of group A Streptococcus infection such as thrombotic events.
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Affiliation(s)
- Joana Jardim
- Neonatology Unit, Centro Hospitalar Universitário de São João, Porto, PRT
| | - Sara Araújo
- Neonatology Unit, Centro Hospitalar Entre-Douro-e-Vouga, Santa Maria da Feira, PRT
| | - Teresa Andrade
- Neonatology Unit, Centro Hospitalar Entre-Douro-e-Vouga, Santa Maria da Feira, PRT
| | - Teresa Caldeira
- Neonatology Unit, Centro Hospitalar Entre-Douro-e-Vouga, Santa Maria da Feira, PRT
| | - Paulo Soares
- Neonatology Unit, Centro Hospitalar Universitário de São João, Porto, PRT
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Mercadante S, Ficari A, Romani L, De Luca M, Tripiciano C, Chiurchiù S, Calo Carducci FI, Cursi L, Di Giuseppe M, Krzysztofiak A, Bernardi S, Lancella L. The Thousand Faces of Invasive Group A Streptococcal Infections: Update on Epidemiology, Symptoms, and Therapy. CHILDREN (BASEL, SWITZERLAND) 2024; 11:383. [PMID: 38671600 PMCID: PMC11048970 DOI: 10.3390/children11040383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/15/2024] [Accepted: 03/20/2024] [Indexed: 04/28/2024]
Abstract
Invasive infections caused by Streptococcus pyogfenes (iGAS), commonly known as Group A Streptococcus, represent a significant public health concern due to their potential for rapid progression and life-threatening complications. Epidemiologically, invasive GAS infections exhibit a diverse global distribution, affecting individuals of all ages with varying predisposing factors. The pathogenesis of invasive GAS involves an array of virulence factors that contribute to tissue invasion, immune evasion, and systemic dissemination. In pediatrics, in the last few years, an increase in iGAS infections has been reported worldwide becoming a challenging disease to diagnose and treat promptly. This review highlights the current knowledge on pathogenesis, clinical presentations, and therapeutic approaches for iGAS in children.
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Affiliation(s)
- Stefania Mercadante
- Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.M.); (L.R.); (C.T.); (S.C.); (S.B.); (L.L.)
| | - Andrea Ficari
- Residency School of Pediatrics, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Lorenza Romani
- Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.M.); (L.R.); (C.T.); (S.C.); (S.B.); (L.L.)
| | - Maia De Luca
- Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.M.); (L.R.); (C.T.); (S.C.); (S.B.); (L.L.)
| | - Costanza Tripiciano
- Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.M.); (L.R.); (C.T.); (S.C.); (S.B.); (L.L.)
| | - Sara Chiurchiù
- Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.M.); (L.R.); (C.T.); (S.C.); (S.B.); (L.L.)
| | - Francesca Ippolita Calo Carducci
- Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.M.); (L.R.); (C.T.); (S.C.); (S.B.); (L.L.)
| | - Laura Cursi
- Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.M.); (L.R.); (C.T.); (S.C.); (S.B.); (L.L.)
| | - Martina Di Giuseppe
- Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.M.); (L.R.); (C.T.); (S.C.); (S.B.); (L.L.)
| | - Andrzej Krzysztofiak
- Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.M.); (L.R.); (C.T.); (S.C.); (S.B.); (L.L.)
| | - Stefania Bernardi
- Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.M.); (L.R.); (C.T.); (S.C.); (S.B.); (L.L.)
| | - Laura Lancella
- Infectious Disease Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (S.M.); (L.R.); (C.T.); (S.C.); (S.B.); (L.L.)
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Abo YN, Oliver J, McMinn A, Osowicki J, Baker C, Clark JE, Blyth CC, Francis JR, Carr J, Smeesters PR, Crawford NW, Steer AC. Increase in invasive group A streptococcal disease among Australian children coinciding with northern hemisphere surges. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 41:100873. [PMID: 38223399 PMCID: PMC10786649 DOI: 10.1016/j.lanwpc.2023.100873] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 07/23/2023] [Indexed: 01/16/2024]
Abstract
Background Increases in invasive group A streptococcal disease (iGAS) have recently been reported in multiple countries in the northern hemisphere, occurring during, and outside of, typical spring peaks. We report the epidemiology of iGAS among children in Australia from 1 July 2018 to 31 December 2022. Methods The Paediatric Active Enhanced Disease Surveillance (PAEDS) Network prospectively collected iGAS patient notifications for children and young people aged less than 18 years admitted to five major Australian paediatric hospitals in Victoria, Queensland, Western Australia and the Northern Territory. Patients were eligible for inclusion if they had GAS isolated from a normally sterile body site, or met clinical criteria for streptococcal toxic shock syndrome or necrotising fasciitis with GAS isolated from a non-sterile site. We report patients' clinical and demographic characteristics, and estimate minimum incidence rates. Findings We identified 280 paediatric iGAS patients, median age 4.5 years (interquartile range 1.4-6.4). We observed a pre-pandemic peak annualised incidence of 3.7 per 100,000 (95% CI 3.1-4.4) in the 3rd quarter of 2018, followed by a decline to less than 1.0 per 100,000 per quarter from 2020 to mid-2021. The annualised incidence increased sharply from mid-2022, peaking at 5.2 per 100,000 (95% CI 4.4-6.0) in the 3rd quarter and persisting into the 4th quarter (4.9 per 100,000, 95% CI 4.2-5.7). There were 3 attributable deaths and 84 (32%) patients had severe disease (overall case fatality rate 1%, 95% CI 0.2-3.3). Respiratory virus co-infection, positive in 57 of 119 patients tested, was associated with severe disease (RR 1.9, 95% CI 1.2-3.0). The most common emm-type was emm-1 (60 of 163 isolates that underwent emm-typing, 37%), followed by emm-12 (18%). Interpretation Australia experienced an increase in the incidence of iGAS among children and young people in 2022 compared to pandemic years 2020-2021. This is similar to northern hemisphere observations, despite differences in seasons and circulating respiratory viruses. Outbreaks of iGAS continue to occur widely. This emphasises the unmet need for a vaccine to prevent significant morbidity associated with iGAS disease. Funding Murdoch Children's Research Institute funded open access publishing of this manuscript.
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Affiliation(s)
- Yara-Natalie Abo
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Infectious Diseases Unit, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Microbiology, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Jane Oliver
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Victoria, Australia
| | - Alissa McMinn
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Joshua Osowicki
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Infectious Diseases Unit, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Ciara Baker
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Julia E. Clark
- Queensland Children's Hospital, Queensland and School of Clinical Medicine, University of Queensland, Australia
| | - Christopher C. Blyth
- Telethon Kids Institute, University of Western Australia and Perth Children's Hospital, Western Australia, Australia
| | - Joshua R. Francis
- Royal Darwin Hospital, Northern Territory, Australia
- Menzies School of Health Research, Charles Darwin University, Northern Territory, Australia
| | - Jeremy Carr
- Infection & Immunity, Monash Children's Hospital, Melbourne, Victoria, Australia
- Monash University, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Pierre R. Smeesters
- Department of Paediatrics, Brussels University Hospital, Academic Children Hospital Queen Fabiola, Université libre de Bruxelles, 1020 Brussels, Belgium
- Molecular Bacteriology Laboratory, Université Libre de Bruxelles, 1070 Brussels, Belgium
| | - Nigel W. Crawford
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Andrew C. Steer
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Infectious Diseases Unit, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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Sokou R, Filippatos F, Daniil V, Bikouli ED, Tsantes AG, Piovani D, Bonovas S, Iliodromiti Z, Boutsikou T, Tsantes AE, Iacovidou N, Konstantinidi A. Group A Streptococcus Infection in Neonatal Population: A Systematic Review of The Literature. J Clin Med 2023; 12:6974. [PMID: 38002589 PMCID: PMC10672068 DOI: 10.3390/jcm12226974] [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: 10/16/2023] [Revised: 11/02/2023] [Accepted: 11/04/2023] [Indexed: 11/26/2023] Open
Abstract
(1) Background: The importance of group A streptococcus (GAS) infection severity has been recognized in children and adults. However, to our knowledge, there have been no systematic reviews or pooled assessments of the incidence and outcome of invasive GAS (iGAS) disease in neonates, a potentially high-risk population. Therefore, we performed a systematic review of available data regarding the risk factors, clinical presentation, and outcome of GAS infection in neonates. (2) Methods: An electronic search of the existing literature was carried out during the period July 2023-September 2023 in the PubMed and Scopus databases, considering studies referring to GAS infection in the neonatal population. (3) Results: Overall, 39 studies met all the inclusion criteria and were included in this review, evaluating data from 194 neonates. Unfortunately, there were a lot of missing data among the retrieved studies. Our systematic review highlighted the presence of differences with regards to clinical presentation, infection sites, and outcome of GAS invasive disease between neonates with early-onset (EOS) or late-onset sepsis (LOS). Common characteristics of EOS included respiratory distress, rapid deterioration, and high mortality rate irrespective of the infection site, while rash, gastrointestinal tract symptoms, and fever appeared to be the most frequent symptoms/clinical signs and manifestations of LOS disease. The management of severe invasive iGAS disease consists mainly of specific antimicrobial treatment as well as supportive care with fluids and electrolyte supplementation, minimizing or counteracting the effects of toxins. Furthermore, a mortality rate of approximately 14% was recorded for iGAS disease in the total of all studies' neonates. (4) Conclusions: Although iGAS is a rare entity of neonatal infections, the potential severity of the disease and the rapid deterioration requires the development of quick analysis methods for the detection of GAS allowing the prompt diagnosis and administration of the indicated antibiotic treatment. Furthermore, given the exceptional risk for both the pregnant woman and the neonate, it is very important to raise awareness and create easily accessible guidelines that could facilitate the prevention and management of maternal as well as the subsequent neonatal severe iGAS disease.
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Affiliation(s)
- Rozeta Sokou
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 18454 Piraeus, Greece; (E.-D.B.); (A.K.)
- Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece; (F.F.); (V.D.); (Z.I.); (T.B.); (N.I.)
| | - Filippos Filippatos
- Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece; (F.F.); (V.D.); (Z.I.); (T.B.); (N.I.)
| | - Vasiliki Daniil
- Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece; (F.F.); (V.D.); (Z.I.); (T.B.); (N.I.)
| | - Efstathia-Danai Bikouli
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 18454 Piraeus, Greece; (E.-D.B.); (A.K.)
| | - Andreas G. Tsantes
- Microbiology Department, “Saint Savvas” Oncology Hospital, 11522 Athens, Greece;
| | - Daniele Piovani
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy; (D.P.); (S.B.)
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Stefanos Bonovas
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy; (D.P.); (S.B.)
- IRCCS Humanitas Research Hospital, Rozzano, 20089 Milan, Italy
| | - Zoi Iliodromiti
- Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece; (F.F.); (V.D.); (Z.I.); (T.B.); (N.I.)
| | - Theodora Boutsikou
- Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece; (F.F.); (V.D.); (Z.I.); (T.B.); (N.I.)
| | - Argirios E. Tsantes
- Laboratory of Haematology and Blood Bank Unit, “Attiko” Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece;
| | - Nicoletta Iacovidou
- Neonatal Department, National and Kapodistrian University of Athens, Aretaieio Hospital, 11528 Athens, Greece; (F.F.); (V.D.); (Z.I.); (T.B.); (N.I.)
| | - Aikaterini Konstantinidi
- Neonatal Intensive Care Unit, “Agios Panteleimon” General Hospital of Nikea, 18454 Piraeus, Greece; (E.-D.B.); (A.K.)
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Coşkun ZN, Erat T, Gülhan B, Koçkuzu E, Bayhan Gİ, Parlakay AÖ. Case Series With Streptococcus pyogenes -related Toxic Shock Syndrome in the Post-COVID Period [RETRACTED]. Pediatr Infect Dis J 2023:00006454-990000000-00623. [PMID: 37922480 DOI: 10.1097/inf.0000000000004152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2023]
Affiliation(s)
| | - Tuğba Erat
- From the Department of Pediatric Infectious Diseases
| | - Belgin Gülhan
- From the Department of Pediatric Infectious Diseases
| | - Esra Koçkuzu
- Department of Pediatric Intensive Care Unit, Ankara City Hospital, Ankara, Turkey
| | - Gülsüm İclal Bayhan
- Department of Pediatric Infectious Diseases, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
| | - Aslinur Özkaya Parlakay
- Department of Pediatric Infectious Diseases, Ankara Yildirim Beyazit University, Ankara City Hospital, Ankara, Turkey
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Paspaliari DK, Sarvikivi E, Ollgren J, Vuopio J. Invasive beta-haemolytic streptococcal infections, Finland, 2006 to 2020: increase in Lancefield group C/G infections. Euro Surveill 2023; 28:2200807. [PMID: 37535473 PMCID: PMC10401913 DOI: 10.2807/1560-7917.es.2023.28.31.2200807] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/13/2023] [Indexed: 08/05/2023] Open
Abstract
BackgroundInvasive infections with beta-haemolytic streptococci of Lancefield groups A (iGAS), B (iGBS) and C/G (iGCGS) are a major cause of morbidity and mortality worldwide.AimWe studied incidence trends of invasive beta-haemolytic streptococcal infections in Finland, focusing on iGCGS.MethodsWe conducted a retrospective register-based study. Cases were defined as isolations from blood and/or cerebrospinal fluid and retrieved from the National Infectious Disease Register where all invasive cases are mandatorily notified.ResultsBetween 2006 and 2020, the mean annual incidence was 4.1 per 100,000 for iGAS (range: 2.1-6.7), 5.2 for iGBS (4.0-6.3) and 10.1 for iGCGS (5.4-17.6). The incidence displayed an increasing trend for all groups, albeit for iGBS only for individuals 45 years and older. The increase was particularly sharp for iGCGS (8% annual relative increase). The incidence rate was higher in males for iGCGS (adjusted incidence rate ratio (IRR) = 1.6; 95% confidence interval (CI): 1.5-1.8) and iGAS (adjusted IRR = 1.3; 95% CI: 1.1-1.4); for iGBS, the association with sex was age-dependent. In adults, iGCGS incidence increased significantly with age. Recurrency was seen for iGCGS and secondarily iGBS, but not for iGAS. Infections with iGCGS and iGBS peaked in July and August.ConclusionsThe incidence of invasive beta-haemolytic streptococcal infections in Finland has been rising since 2006, especially for iGCGS and among the elderly population. However, national surveillance still focuses on iGAS and iGBS, and European Union-wide surveillance is lacking. We recommend that surveillance of iGCGS be enhanced, including systematic collection and typing of isolates, to guide infection prevention strategies.
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Affiliation(s)
- Dafni Katerina Paspaliari
- Finnish Institute of Health and Welfare, Helsinki, Finland
- ECDC Fellowship Programme, Public Health Microbiology path (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Emmi Sarvikivi
- Finnish Institute of Health and Welfare, Helsinki, Finland
| | - Jukka Ollgren
- Finnish Institute of Health and Welfare, Helsinki, Finland
| | - Jaana Vuopio
- Finnish Institute of Health and Welfare, Helsinki, Finland
- University of Turku, Institute of Biomedicine, Turku, Finland
- Turku University Hospital, Clinical Microbiology, Turku, Finland
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Takia L, Lodha R. Toxic Shock Syndrome: A Diagnostic and Therapeutic Challenge! Indian J Pediatr 2023; 90:321-322. [PMID: 36635581 PMCID: PMC9836917 DOI: 10.1007/s12098-023-04478-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 01/02/2023] [Accepted: 01/05/2023] [Indexed: 01/14/2023]
Affiliation(s)
- Lalit Takia
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Mariani F, Martino L, Gentili C, Pulcinelli V, Valentini P, Buonsenso D. State-of-the-art of invasive Group A Streptococcus infection in children: protocol for a scoping review of the literature with a focus on predictors of invasive infection. F1000Res 2023; 12:209. [PMID: 38778805 PMCID: PMC11109578 DOI: 10.12688/f1000research.130989.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2023] [Indexed: 05/25/2024] Open
Abstract
Background: Invasive group A streptococcus infection (iGAS) is a serious, sometimes life-threatening condition, with high case fatality rates and high morbidity whose incidence is greatly increased in the last years. Despite the increasing importance and frequency of this condition, at the best of our knowledge, no previous reviews have been published focusing on the risk factors for the development of this condition and its early clinical features. This paper reports the study protocol for a scoping review that aims to analyze the early signs and clinical features of invasive group A streptococcus disease in children, to recognize the prodromal stage of the disease. Methods: Comprehensive research combining the terms pediatric and invasive group A streptococcus infection has been performed on PubMed and SCOPUS to identify potential eligible studies. The search strategy for PubMed will be available in this paper. Two reviewers will screen first the abstract and subsequently the full text to identify eligible articles according to the predefined inclusion criteria. Divergences between the reviewers will be resolved by discussion (with a third author if necessary). Two review authors will extract data independently, everyone on a different Excel spreadsheet. Each researcher will be blinded to the decision of the other researcher. When the process will be completed, in case of discordance, any disagreement will be identified and resolved through discussion (with a third author if necessary). Dissemination: The findings of this review will be published in a peer-reviewed journal.
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Affiliation(s)
- Francesco Mariani
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy, Roma, Italy
| | - Laura Martino
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy, Roma, Italy
| | - Carolina Gentili
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy, Roma, Italy
| | - Valentina Pulcinelli
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy, Roma, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy, Roma, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy, Roma, Italy
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Paediatric group A streptococcal disease in England from October to December, 2022. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:e2-e4. [PMID: 36566755 DOI: 10.1016/s2352-4642(22)00374-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
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14
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Zhou Q, Li Q, Meng W, Luo Z, Chen Y. Statistical concerns for meta-analysis of rare events and small sample sizes. THE LANCET. INFECTIOUS DISEASES 2022; 22:1111. [PMID: 35870454 DOI: 10.1016/s1473-3099(22)00363-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 05/26/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Qi Zhou
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Lanzhou University GRADE Centre, Lanzhou, China; Lanzhou University, an Affiliate of the Cochrane China Network, Lanzhou, China
| | - Qinyuan Li
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Centre for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Wenbo Meng
- Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou University, Lanzhou, China
| | - Zhengxiu Luo
- Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, National Clinical Research Centre for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
| | - Yaolong Chen
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Lanzhou University GRADE Centre, Lanzhou, China; Lanzhou University, an Affiliate of the Cochrane China Network, Lanzhou, China.
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Sherwood E, Steer AC, Van Beneden CA, Seale AC. Statistical concerns for meta-analysis of rare events and small sample sizes - Authors' reply. THE LANCET. INFECTIOUS DISEASES 2022; 22:1112. [PMID: 35870455 DOI: 10.1016/s1473-3099(22)00358-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 05/26/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Emma Sherwood
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK.
| | - Andrew C Steer
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | | | - Anna C Seale
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
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Zhou S, Shen C. Statistical concerns for meta-analysis of rare events and small sample sizes. THE LANCET INFECTIOUS DISEASES 2022; 22:1111-1112. [DOI: 10.1016/s1473-3099(22)00364-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 05/26/2022] [Indexed: 12/12/2022]
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17
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Helmig RB. Recognising group A streptococcal disease in pregnancy. THE LANCET. INFECTIOUS DISEASES 2022; 22:928-929. [PMID: 35390295 DOI: 10.1016/s1473-3099(21)00745-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/12/2021] [Indexed: 06/14/2023]
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