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Farias LABG, Sousa MM, Cavalcante KF, Jucá MPC, Castro ADO, Mello LP, Mesquita RF, Bandeira SP, Marchi AP, Coelho TMS, Lima Neto AS, Arruda ÉAGD, Costa SF, Oliveira MSD, Perdigão Neto LV. Streptococcus equi subspecies zooepidemicus: an emergent cause of meningoencephalitis in Northeastern Brazil. Rev Inst Med Trop Sao Paulo 2024; 66:e51. [PMID: 39194143 PMCID: PMC11348796 DOI: 10.1590/s1678-9946202466051] [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: 04/29/2024] [Accepted: 07/02/2024] [Indexed: 08/29/2024] Open
Abstract
This study describes an outbreak of Streptococcus equi subspecies zooepidemicus infections that caused meningoencephalitis and bacteremia related to unpasteurized milk consumption in northeastern Brazil. Epidemiological investigations and a brief literature review were conducted. Strains with possible neurotropism had not been identified in Brazil before these cases; however, in 2023, another case of meningoencephalitis caused by Streptococcus equi sp. zooepidemicus was described, revealing the need to maintain surveillance and highlighting that these neurotropic strains continue to circulate in the environment.
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Affiliation(s)
- Luis Arthur Brasil Gadelha Farias
- Universidade de São Paulo, Hospital das Clínicas, Departamento de Doenças Infecciosas, Laboratório de Investigação Médica (LIM 49) São Paulo, São Paulo, Brazil
- Hospital São José de Doenças Infecciosas, Fortaleza, Ceará, Brazil
| | | | | | | | | | | | | | | | - Ana Paula Marchi
- Universidade de São Paulo, Hospital das Clínicas, Departamento de Doenças Infecciosas, Laboratório de Investigação Médica (LIM 49) São Paulo, São Paulo, Brazil
| | - Tânia Mara Silva Coelho
- Universidade Federal do Ceará, Programa de Pós-Graduação em Saúde Coletiva, Fortaleza, Ceará, Brazil
- Secretaria de Saúde do Estado do Ceará, Fortaleza, Ceará, Brazil
| | | | | | - Silvia Figueiredo Costa
- Universidade de São Paulo, Hospital das Clínicas, Departamento de Doenças Infecciosas, Laboratório de Investigação Médica (LIM 49) São Paulo, São Paulo, Brazil
| | - Maura Salaroli de Oliveira
- Universidade de São Paulo, Hospital das Clínicas, Departamento de Doenças Infecciosas, Laboratório de Investigação Médica (LIM 49) São Paulo, São Paulo, Brazil
| | - Lauro Vieira Perdigão Neto
- Universidade de São Paulo, Hospital das Clínicas, Departamento de Doenças Infecciosas, Laboratório de Investigação Médica (LIM 49) São Paulo, São Paulo, Brazil
- Hospital São José de Doenças Infecciosas, Fortaleza, Ceará, Brazil
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Glomerulonefritis aguda postinfecciosa por Streptococcus equi en paciente pediátrico. Enferm Infecc Microbiol Clin 2021; 39:50-51. [PMID: 32534744 DOI: 10.1016/j.eimc.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: 04/04/2020] [Revised: 05/05/2020] [Accepted: 05/08/2020] [Indexed: 10/24/2022]
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Sepsis, Endocarditis, and Purulent Arthritis due to a Rare Zoonotic Infection with Streptococcus equi Subspecies zooepidemicus. Case Rep Infect Dis 2018; 2018:3265701. [PMID: 30013802 PMCID: PMC6022317 DOI: 10.1155/2018/3265701] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 05/21/2018] [Indexed: 11/17/2022] Open
Abstract
Streptococcus equi subspecies zooepidemicus (S. zooepidemicus) is mostly known as an opportunistic pathogen found in horses and as a rare human zoonosis. An 82-year-old male, who had daily contact with horses, was admitted in a septic condition. The patient presented with dyspnea, hemoptysis, impaired general condition, and severe pain in a swollen left shoulder. Synovial fluid from the affected joint and blood cultures showed growth of S. equi subsp. zooepidemicus. Transesophageal echocardiography showed a vegetation on the aortic valve consistent with endocarditis. Arthroscopic revision revealed synovitis and erosion of the rotator cuff. Technetium-99m scintigraphy showed intense increased activity in the left shoulder, suspicious of osteitis. The infection was treated with intravenous antibiotics over a period of five weeks, followed by oral antibiotics for another two months. The patient recovered without permanent sequelae.
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Maharaj S, Seegobin K, Chrzanowski S, Chang S. Acute glomerulonephritis secondary to Streptococcus anginosus. BMJ Case Rep 2018. [PMID: 29523515 DOI: 10.1136/bcr-2017-223314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Streptococcus anginosus is a clinically important pathogen that is emerging globally but remains poorly investigated. Here, we report the first case of acute glomerulonephritis resulting from infection with S. anginosus Glomerulonephritis is typically caused by S. pyogenes and reports secondary to other strains including S. zooepidemicus and S. constellatus exist. Infection with S. anginosus in this patient was associated with acute nephritis (haematuria, oedema and hypertension), nephrotic syndrome and progressive azotemia. There was activation of the complement system. The presence of low C1q and elevated anti-C1q binding complexes points to a potential pathogenic role. Testing for streptococcal antigens was strongly positive. Emerging nephritogenic strains of S. anginosus present a significant health concern for both developed and developing countries.
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Affiliation(s)
- Satish Maharaj
- Internal Medicine, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Karan Seegobin
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | | | - Simone Chang
- Hotz Children's Hospital, Jackson Health Sysrem, Miami, Florida, USA
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Le-Berre N, Filipozzi P, Martin L, Frimat L, Girerd S. Glomérulonéphrite aiguë post-infectieuse à Streptococcus equi subsp. zooepidemicus : premier cas décrit en France. Nephrol Ther 2017; 13:37-41. [DOI: 10.1016/j.nephro.2016.07.448] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 07/09/2016] [Accepted: 07/25/2016] [Indexed: 11/30/2022]
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Pinto SWL, Mastroianni-Kirsztajn G, Sesso R. Ten-Year Follow-up of Patients with Epidemic Post Infectious Glomerulonephritis. PLoS One 2015; 10:e0125313. [PMID: 25962068 PMCID: PMC4427285 DOI: 10.1371/journal.pone.0125313] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 03/18/2015] [Indexed: 12/15/2022] Open
Abstract
Background Scarce information on outcomes of epidemic post infectious glomerulonephritis is available. This is a 10-year follow-up of the patients that developed acute glomerulonephritis in an epidemic outbreak caused by group C Streptococcus zooepidemicus in Brazil in 1998, that were also previously evaluated 2 and 5 years after the acute episode. Methods In this prospective study 60 cases (out of 134 in 1998) were reevaluated after 10 years, as well as community controls matched by gender and age. They underwent clinical and renal function evaluation, including serum creatinine and cystatin C, estimated glomerular filtration rate (eGFR), albuminuria and hematuria. Results Comparisons of clinical and renal function aspects of 60 patients and 48 community controls have not shown significant differences (eGFR <60 ml/min/1.73m2 and/or albuminuria >30mg/g creatinine: 13.8% vs. 12.2%, respectively, p = 0.817) except for a higher frequency of hypertension in the cases (45.0% vs. 20.8%, p = 0.009). Comparing the same patients affected in the acute episode, 2, 5 and 10 years later, it was observed an improvement of median eGFR levels at 2 years and a trend toward subsequent stabilization in these levels, associated with decrease in albuminuria and increased hypertension rates in the last survey. At 10 years it was not observed additional reduction of renal function using serum creatinine, eGFR and cystatin C. Conclusions During the acute episode of epidemic GN a considerable proportion of patients presented hypertension and reduced renal function; after 2 years and particularly at this 10-year follow-up survey there was no worsening of renal function parameters, except for persistent higher frequency of hypertension. Nevertheless, a longer follow up is necessary to confirm that progressive loss of renal function will not occur.
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Affiliation(s)
| | | | - Ricardo Sesso
- Division of Nephrology, Federal University of Sao Paulo, Sao Paulo-SP, Brazil
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Nasr SH, Radhakrishnan J, D'Agati VD. Bacterial infection-related glomerulonephritis in adults. Kidney Int 2013; 83:792-803. [PMID: 23302723 DOI: 10.1038/ki.2012.407] [Citation(s) in RCA: 141] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In the past, most cases of bacterial infection-related glomerulonephritis (IRGN) occurred in children following streptococcal upper respiratory tract or skin infections and were called postinfectious GN. Over the past 3 decades, there has been an important shift in epidemiology, bacteriology, and outcome of IRGN. A significant percentage of cases now target adults, particularly the elderly or immunocompromised. Because adult infections are often ongoing at the time of diagnosis, the term IRGN appears more appropriate. The sites of infection in adult IRGN are more heterogeneous than in children, and include the upper respiratory tract, skin, lung, heart, urinary tract, teeth/oral mucosa, and bone. In adults, the disease is more likely to be secondary to non-streptococcal infections, particularly staphylococcal infection. In contrast to the favorable course in children, a significant proportion of adults with IRGN, especially the elderly and diabetics, do not recover renal function. Whereas the pathogenesis of post-streptococcal glomerulonephritis has been studied extensively, leading to the identification of two candidate nephritogenic streptococcal antigens, glyceraldehyde-3-phosphate dehydrogenase and pyrogenic exotoxin B, few investigations have focused on IRGN caused by other bacteria. This review will address the current status of sporadic bacterial IRGN in adults.
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Affiliation(s)
- Samih H Nasr
- Department of Laboratory Medicine and Pathology, Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Abbott Y, Acke E, Khan S, Muldoon EG, Markey BK, Pinilla M, Leonard FC, Steward K, Waller A. Zoonotic transmission of Streptococcus equi subsp. zooepidemicus from a dog to a handler. J Med Microbiol 2010; 59:120-123. [PMID: 19745031 DOI: 10.1099/jmm.0.012930-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This is, to the best of our knowledge, the first case report to describe the apparent transmission of Streptococcus equi subsp. zooepidemicus from an infected dog to a handler who subsequently developed severe systemic infection. Characterization of the haemolytic streptococci isolated from both the patient and the dog, by phenotypic and molecular analysis, confirmed the canine and human isolates were identical.
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Affiliation(s)
- Y Abbott
- Veterinary Sciences, Veterinary Sciences Centre, School of Agriculture, Food Science and Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - E Acke
- Veterinary Sciences, Veterinary Sciences Centre, School of Agriculture, Food Science and Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - S Khan
- Beacon Hospital, Sandyford, Dublin 18, Ireland
| | - E G Muldoon
- St James's Hospital, James's Street, Dublin 8, Ireland
| | - B K Markey
- Veterinary Sciences, Veterinary Sciences Centre, School of Agriculture, Food Science and Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - M Pinilla
- Veterinary Sciences, Veterinary Sciences Centre, School of Agriculture, Food Science and Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - F C Leonard
- Veterinary Sciences, Veterinary Sciences Centre, School of Agriculture, Food Science and Veterinary Medicine, University College Dublin, Belfield, Dublin 4, Ireland
| | - K Steward
- Centre for Preventive Medicine, Animal Health Trust, Newmarket, UK
| | - A Waller
- Centre for Preventive Medicine, Animal Health Trust, Newmarket, UK
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Abstract
The rising global burden of chronic renal disease, the high cost of providing renal replacement therapies, and renal disease also being a risk factor for cardiovascular disease is increasing focus on renal disease prevention. This article focuses on the aspects of renal disease (specifically poststreptococcal glomerulonephritis [PSGN] and chronic kidney disease [CKD]) in Indigenous populations in Australia, New Zealand, Canada, and the United States that diverge from those typically seen in the general population of those countries. The spectrum of renal and many other diseases seen in Indigenous people in developed countries is similar to that seen in developing countries. Diseases like PSGN that have largely disappeared in developed countries still occur frequently in Indigenous people. CKD during the childhood years is due to congenital anomalies of the kidney and urinary tract in up to 70% of cases and occurs later in polycystic kidney disease and childhood-onset diabetes. Several risk factors for CKD in adulthood are already present in childhood.
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Affiliation(s)
- Gurmeet R Singh
- Child Health Division, Menzies School of Health Research, Charles Darwin University Darwin, PO Box 41096, Casuarina, NT 0810, Australia.
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