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Solanki P, Colaco C, Dotel R. Analysis of bacteraemia caused by group C and G Streptococcus (Streptococcus dysgalactiae subsp. equisimilis) in Western Sydney over a 6-year period (2015-2020). Eur J Clin Microbiol Infect Dis 2024; 43:1807-1814. [PMID: 39008148 DOI: 10.1007/s10096-024-04903-x] [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: 06/21/2024] [Accepted: 07/09/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE Streptococcus dysgalactiae subsp. equisimilis (SDSE) has increasingly been recognised as a significant pathogen that causes a myriad of infections, ranging from cellulitis to invasive infections, including bacteraemia and even toxic shock syndrome. The aim of this study was to examine the epidemiology and disease manifestations of bacteraemia caused by SDSE. METHODS We retrospectively reviewed cases of SDSE bacteraemia in adults aged ≥ 18 years admitted to four public hospitals in Western Sydney, Australia, between January 2015 and December 2020. We reviewed demographics, comorbidities, disease manifestations, management, and outcomes. RESULTS There were 108 patients with SDSE bacteraemia over a six-year period. The median age of individuals with SDSE bacteraemia was 70 years (interquartile range, IQR, 58-85 years). Cardiovascular disease (46%), chronic skin conditions (44%) and diabetes (37%) were the most common comorbidities. Ten patients (9%) with SDSE bacteraemia had healthcare-acquired infections. Skin and skin structure infections (SSTIs) were the most common presentations (59%), while bone and joint infections (BJIs) represented 13% of the cases. Twenty patients (19%) had septic shock on presentation. Fifteen patients (14%) were prescribed clindamycin, while one patient received intravenous immunoglobulin (IVIg). Infective endocarditis (IE) was present in 3% of patients; however, only 44% of the total patients had an echocardiogram. The 30-day mortality rate was 13%, but it was greater in those aged > 75 years (21%). The average length of hospital stay for patients who survived was 15 days, and the average duration of intravenous therapy was 12 days. CONCLUSION SDSE bacteraemia is typically a community-onset infection with a fifth of patients in our cohort presenting with septic shock. Though complications such as BJI (13%) and IE (3%) are infrequent, 30-day mortality is high at 21% in those aged > 75 years.
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Affiliation(s)
- Parthsinh Solanki
- Department of Infectious Diseases, Blacktown Hospital, Sydney, NSW, Australia.
- School of Clinical Medicine, University of New South Wales, Sydney, NSW, Australia.
| | - Clinton Colaco
- Centre for Infectious Diseases and Microbiology, Westmead Hospital, Sydney, NSW, Australia
- The University of Sydney, Westmead Clinical School, Sydney, NSW, Australia
| | - Ravindra Dotel
- Department of Infectious Diseases, Blacktown Hospital, Sydney, NSW, Australia
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Hanada S, Wajima T, Takata M, Morozumi M, Shoji M, Iwata S, Ubukata K. Clinical manifestations and biomarkers to predict mortality risk in adults with invasive Streptococcus dysgalactiae subsp. equisimilis infections. Eur J Clin Microbiol Infect Dis 2024; 43:1609-1619. [PMID: 38847928 PMCID: PMC11271329 DOI: 10.1007/s10096-024-04861-4] [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: 03/08/2024] [Accepted: 05/23/2024] [Indexed: 07/21/2024]
Abstract
PURPOSE The incidence of invasive Streptococcus dysgalactiae subsp. equisimilis (iSDSE) infections is increasing in developed countries, but studies on the risk factors for death in iSDSE infections are scant. Here, we aimed to clarify risk factors and predictors of mortality in adults with iSDSE infections. METHODS A multicentre observational study of adults with iSDSE infections was conducted to investigate the effects of host factors, disease severity, biomarkers, and antibiotic regimens, and bacterial factors on 28-day mortality. RESULTS The overall mortality rate of 588 patients was 10.4%, with a significant increase in those aged ≥ 60 years. Most of the patients (97.4%) had underlying diseases. The mortality rate (70.4%) of patients with severe disease was significantly higher than that of patients with mild-to-moderate disease (4.3%; p < 0.001). The risk factors for death identified using multivariable analysis were age ≥ 60 years (hazard ratio [HR], 3.4; 95% confidence interval [CI], 1.0-11.3, p = 0.042); severe disease (HR, 15.0; 95% CI 7.7-29.2, p < 0.001); bacteraemia without primary focus (HR, 20.5; 95% CI 2.8-152.3, p = 0.003); serum creatinine ≥ 2.0 mg/dL (HR, 2.2; 95% CI 1.2-4.0, p = 0.010); serum creatine kinase ≥ 300 IU/L (HR, 2.1; 95% CI 1.1-3.8, p = 0.019); and macrolide resistance (HR, 1.8; 95% CI 1.0-3.3, p = 0.048). Treatment regimens and emm types were not associated with poor outcomes. CONCLUSION Evaluation of clinical manifestations and biomarkers on admission is important to predict invasive SDSE infection prognosis.
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Affiliation(s)
- Shigeo Hanada
- Department of Respiratory Medicine, Respiratory Center, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
- Okinaka Memorial Institute for Medical Research, Tokyo, Japan.
- Department of Microbiology, Tokyo Medical University, Tokyo, Japan.
| | - Takeaki Wajima
- Department of Microbiology, Faculty of Pharmacy, Meijo University, Nagoya, Japan
| | - Misako Takata
- Department of Microbiology, Tokyo Medical University, Tokyo, Japan
| | - Miyuki Morozumi
- Department of Microbiology, Tokyo Medical University, Tokyo, Japan
| | - Michi Shoji
- Department of Infectious Disease, National Sanatorium Tamazenshoen, Tokyo, Japan
| | - Satoshi Iwata
- Department of Microbiology, Tokyo Medical University, Tokyo, Japan
| | - Kimiko Ubukata
- Department of Microbiology, Tokyo Medical University, Tokyo, Japan
- Center for General Medicine Education, Keio University School of Medicine, Tokyo, Japan
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Tsujino A, Nakajima A, Yabuta H, Sekioka J, Amano M, Fujimura S, Akashi Y, Akioka S, Iwasa K, Okazaki A, Takano M, Kajita A, Uno K. An Autopsy Case of Streptococcus dysgalactiae subsp. equisimilis Infectious Endocarditis Accompanied by Streptococcal Toxic Shock Syndrome. Intern Med 2024; 63:2209-2214. [PMID: 39085093 PMCID: PMC11358739 DOI: 10.2169/internalmedicine.2526-23] [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] [Received: 07/11/2023] [Accepted: 10/23/2023] [Indexed: 08/02/2024] Open
Abstract
A 66-year-old woman with liver cirrhosis and hemodialysis was referred with a 1-week history of pain and rash on the left lower leg. On an examination, the patient was in shock. She was administered catecholamine support for septic shock and ampicillin/sulbactam for severe cellulitis. Streptococcus dysgalactiae subsp. equisimilis (SDSE) was isolated from the blood culture, and she was diagnosed with streptococcal toxic shock syndrome. Despite therapy, the patient died on day 7 of admission. Infective endocarditis (IE) was diagnosed during an autopsy. Clinicians should be aware that overwhelming SDSE-IE can occur even in the absence of necrotizing fasciitis, especially in immunocompromised patients.
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Affiliation(s)
- Ayaho Tsujino
- Center of Medical Education and Training, Minami-Nara General Medical Center, Japan
| | - Aki Nakajima
- Center of Medical Education and Training, Minami-Nara General Medical Center, Japan
| | - Haruka Yabuta
- Department of Generalist Medicine, Minami-Nara General Medical Center, Japan
| | - Joi Sekioka
- Department of Generalist Medicine, Minami-Nara General Medical Center, Japan
| | - Masayuki Amano
- Department of Generalist Medicine, Minami-Nara General Medical Center, Japan
| | - Shuhei Fujimura
- Department of Generalist Medicine, Minami-Nara General Medical Center, Japan
| | - Yosuke Akashi
- Department of Generalist Medicine, Minami-Nara General Medical Center, Japan
| | - Shinya Akioka
- Department of Dermatology, Minami-Nara General Medical Center, Japan
| | - Kentaro Iwasa
- Department of Dermatology, Minami-Nara General Medical Center, Japan
| | - Aiko Okazaki
- Department of Dermatology, Minami-Nara General Medical Center, Japan
| | - Masahito Takano
- Department of Clinical Pathology, Minami-Nara General Medical Center, Japan
| | - Akihiro Kajita
- Department of Infectious Diseases, Minami-Nara General Medical Center, Japan
| | - Kenji Uno
- Department of Infectious Diseases, Minami-Nara General Medical Center, Japan
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Xie O, Davies MR, Tong SYC. Streptococcus dysgalactiae subsp. equisimilis infection and its intersection with Streptococcus pyogenes. Clin Microbiol Rev 2024:e0017523. [PMID: 38856686 DOI: 10.1128/cmr.00175-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2024] Open
Abstract
SUMMARYStreptococcus dysgalactiae subsp. equisimilis (SDSE) is an increasingly recognized cause of disease in humans. Disease manifestations range from non-invasive superficial skin and soft tissue infections to life-threatening streptococcal toxic shock syndrome and necrotizing fasciitis. Invasive disease is usually associated with co-morbidities, immunosuppression, and advancing age. The crude incidence of invasive disease approaches that of the closely related pathogen, Streptococcus pyogenes. Genomic epidemiology using whole-genome sequencing has revealed important insights into global SDSE population dynamics including emerging lineages and spread of anti-microbial resistance. It has also complemented observations of overlapping pathobiology between SDSE and S. pyogenes, including shared virulence factors and mobile gene content, potentially underlying shared pathogen phenotypes. This review provides an overview of the clinical and genomic epidemiology, disease manifestations, treatment, and virulence determinants of human infections with SDSE with a particular focus on its overlap with S. pyogenes. In doing so, we highlight the importance of understanding the overlap of SDSE and S. pyogenes to inform surveillance and disease control strategies.
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Affiliation(s)
- Ouli Xie
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Monash Infectious Diseases, Monash Health, Melbourne, Australia
| | - Mark R Davies
- Department of Microbiology and Immunology, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Steven Y C Tong
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Victorian Infectious Disease Service, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
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Xie O, Tong SYC. Heterogeneity in Risk of Newly Classified "Typical" Streptococci as Causes of Infective Endocarditis. Clin Infect Dis 2023; 77:1219-1220. [PMID: 37382033 DOI: 10.1093/cid/ciad392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/23/2023] [Indexed: 06/30/2023] Open
Affiliation(s)
- Ouli Xie
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Monash Infectious Diseases, Monash Health, Melbourne, Australia
| | - Steven Y C Tong
- Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
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Horn DL, Chan JD, Li K, Bulger EM, Lynch JB, Robinson BR, Bryson-Cahn C. Defining the Optimal Antibiotic Duration in Necrotizing Skin and Soft Tissue Infections: Clinical Experience from a Quaternary Referral Center. Surg Infect (Larchmt) 2023; 24:741-748. [PMID: 37751587 PMCID: PMC10615078 DOI: 10.1089/sur.2022.294] [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] [Indexed: 09/28/2023] Open
Abstract
Background: Early initiation of broad-spectrum antibiotic agents is a cornerstone of the care of necrotizing skin and soft tissue infections (NSTI). However, the optimal duration of antibiotic agents is unclear. We sought to characterize antibiotic prescribing patterns for patients with NSTI, as well as associated complications. Patients and Methods: Using an NSTI registry, we characterized antibiotic use at a quaternary referral center. Kaplan-Meier analyses were used to describe overall antibiotic duration and relative to operative source control, stratified by presence of other infections that independently influenced antibiotic duration. Factors associated with successful antibiotic discontinuation were identified using logistic regression. Results: Between 2015 and 2018, 441 patients received antibiotic agents for NSTI with 18% experiencing a complicating secondary infection. Among those without a complicating infection, the median duration of antibiotic administration was 9.8 days (95% confidence interval [CI], 9.2-10.5) overall, and 7.0 days after the final debridement. Perineal NSTI received fewer days of antibiotic agents (8.3 vs. 10.6) compared with NSTI without perineal involvement. White blood cell (WBC) count and fever were not associated with failure of antibiotic discontinuation, however, a chronic wound as the underlying infection etiology was associated with greater odds of antibiotic discontinuation failure (odds ratio [OR], 4.33; 95% CI, 1.24-15.1). Conclusions: A seven-day course of antibiotic agents after final operative debridement may be sufficient for NSTI without any secondary complicating infections, because clinical characteristics do not appear to be associated with differences in successful antibiotic discontinuation.
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Affiliation(s)
- Dara L. Horn
- Division of Trauma and Critical Care, Department of Surgery, University of Washington, Harborview Medical Center, Seattle, Washington, USA
| | - Jeannie D. Chan
- Department of Medicine, Division of Infectious Diseases and Allergy, University of Washington, Seattle, Washington, USA
| | - Kevin Li
- Department of Biomedical Informatics, University of Washington, Seattle, Washington, USA
| | - Eileen M. Bulger
- Division of Trauma and Critical Care, Department of Surgery, University of Washington, Harborview Medical Center, Seattle, Washington, USA
| | - John B. Lynch
- Department of Medicine, Division of Infectious Diseases and Allergy, University of Washington, Seattle, Washington, USA
| | - Bryce R.H. Robinson
- Division of Trauma and Critical Care, Department of Surgery, University of Washington, Harborview Medical Center, Seattle, Washington, USA
| | - Chloe Bryson-Cahn
- Department of Medicine, Division of Infectious Diseases and Allergy, University of Washington, Seattle, Washington, USA
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Shen X, Liang H, Wu G, Chen M, Li J. A Case Report of Streptococcus Dysgalactiae Toxic Shock Syndrome Complicated with Symmetric Peripheral Gangrene. Infect Drug Resist 2023; 16:5977-5983. [PMID: 37705513 PMCID: PMC10496922 DOI: 10.2147/idr.s426930] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023] Open
Abstract
Streptococcus dysgalactiae subspecies equlsimilis (SDSE) is considered an important bacterial pathogen, and attention has also increased with the increasing number of invasive SDSE infections. Here, we report a patient with S. dysgalactiae toxic shock syndrome complicated by symmetrical peripheral gangrene (SPG). Despite surviving active treatment, amputation severely impacts the quality of life of patients. Therefore, we should pay attention to the early treatment of SDSE infection and the prevention and treatment of related complications.
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Affiliation(s)
- Xiaoqing Shen
- Department of Critical Care Medicine, Zhongshan People’s Hospital, Zhongshan, People’s Republic of China
| | - Hongkai Liang
- Department of Critical Care Medicine, Zhongshan People’s Hospital, Zhongshan, People’s Republic of China
| | - Guishen Wu
- Department of Critical Care Medicine, Zhongshan People’s Hospital, Zhongshan, People’s Republic of China
| | - Miaolian Chen
- Department of Critical Care Medicine, Zhongshan People’s Hospital, Zhongshan, People’s Republic of China
| | - Jianwei Li
- Department of Critical Care Medicine, Zhongshan People’s Hospital, Zhongshan, People’s Republic of China
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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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A New Integrative and Mobilizable Element Is a Major Contributor to Tetracycline Resistance in Streptococcus dysgalactiae subsp. equisimilis. Antibiotics (Basel) 2023; 12:antibiotics12030579. [PMID: 36978446 PMCID: PMC10044688 DOI: 10.3390/antibiotics12030579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 03/08/2023] [Accepted: 03/12/2023] [Indexed: 03/17/2023] Open
Abstract
Tetracycline resistance in streptococci is mainly due to ribosomal protection mediated by the tet(M) gene that is usually located in the integrative and conjugative elements (ICEs) of the Tn916-family. In this study, we analyzed the genes involved in tetracycline resistance and the associated mobile genetic elements (MGEs) in Streptococcus dysgalactiae subsp. equisimilis (SDSE) causing invasive disease. SDSE resistant to tetracycline collected from 2012 to 2019 in a single hospital and from 2018 in three other hospitals were analyzed by whole genome sequencing. Out of a total of 84 SDSE isolates, 24 (28.5%) were resistant to tetracycline due to the presence of tet(M) (n = 22), tet(W) (n = 1), or tet(L) plus tet(W) (n = 1). The tet(M) genes were found in the ICEs of the Tn916-family (n = 10) and in a new integrative and mobilizable element (IME; n = 12). Phylogenetic analysis showed a higher genetic diversity among the strains carrying Tn916 than those having the new IME, which were closely related, and all belonged to CC15. In conclusion, tetracycline resistance in SDSE is mostly due to the tet(M) gene associated with ICEs belonging to the Tn916-family and a new IME. This new IME is a major cause of tetracycline resistance in invasive Streptococcus dysgalactiae subsp. equisimilis in our settings.
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Berbel D, González-Díaz A, López de Egea G, Càmara J, Ardanuy C. An Overview of Macrolide Resistance in Streptococci: Prevalence, Mobile Elements and Dynamics. Microorganisms 2022; 10:2316. [PMID: 36557569 PMCID: PMC9783990 DOI: 10.3390/microorganisms10122316] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 11/11/2022] [Accepted: 11/18/2022] [Indexed: 11/24/2022] Open
Abstract
Streptococcal infections are usually treated with beta-lactam antibiotics, but, in case of allergic patients or reduced antibiotic susceptibility, macrolides and fluoroquinolones are the main alternatives. This work focuses on studying macrolide resistance rates, genetic associated determinants and antibiotic consumption data in Spain, Europe and also on a global scale. Macrolide resistance (MR) determinants, such as ribosomal methylases (erm(B), erm(TR), erm(T)) or active antibiotic efflux pumps and ribosomal protectors (mef(A/E)-mrs(D)), are differently distributed worldwide and associated with different clonal lineages and mobile genetic elements. MR rates vary together depending on clonal dynamics and on antibiotic consumption applying selective pressure. Among Streptococcus, higher MR rates are found in the viridans group, Streptococcus pneumoniae and Streptococcus agalactiae, and lower MR rates are described in Streptococcus pyogenes. When considering different geographic areas, higher resistance rates are usually found in East-Asian countries and milder or lower in the US and Europe. Unfortunately, the availability of data varies also between countries; it is scarce in low- and middle- income countries from Africa and South America. Thus, surveillance studies of macrolide resistance rates and the resistance determinants involved should be promoted to complete global knowledge among macrolide resistance dynamics.
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Affiliation(s)
- Dàmaris Berbel
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, 08907 Barcelona, Spain
- Research Network for Respiratory Diseases (CIBERES), ISCIII, 28020 Madrid, Spain
| | - Aida González-Díaz
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, 08907 Barcelona, Spain
- Research Network for Respiratory Diseases (CIBERES), ISCIII, 28020 Madrid, Spain
| | - Guillem López de Egea
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, 08907 Barcelona, Spain
- Research Network for Respiratory Diseases (CIBERES), ISCIII, 28020 Madrid, Spain
| | - Jordi Càmara
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, 08907 Barcelona, Spain
- Research Network for Respiratory Diseases (CIBERES), ISCIII, 28020 Madrid, Spain
| | - Carmen Ardanuy
- Microbiology Department, Hospital Universitari de Bellvitge, IDIBELL-UB, 08907 Barcelona, Spain
- Research Network for Respiratory Diseases (CIBERES), ISCIII, 28020 Madrid, Spain
- Department of Pathology and Experimental Therapeutics, School of Medicine, University of Barcelona, 08007 Barcelona, Spain
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Ghazanfar H, Qureshi Z, Kalangi H, Ata S, Jyala A, Perez EA. Recurrent group G Streptococcus bacteremia: A case report and literature review. Clin Case Rep 2022; 10:e6162. [PMID: 35957769 PMCID: PMC9359971 DOI: 10.1002/ccr3.6162] [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: 03/17/2022] [Accepted: 05/28/2022] [Indexed: 11/15/2022] Open
Abstract
Streptococci group G is an important opportunistic pathogen and causes a wide variety of infections, including pharyngitis, skin and soft tissue infections, bacteremia, endocarditis, septic arthritis, intra-abdominal infections, meningitis, and streptococcal toxic shock-like syndrome. As a result, we discuss an interesting case of recurrent group G streptococcal bacteremia in a 68-year-old man presenting with altered mental status. We also discuss the risk factors, etiology, pathophysiology, diagnosis, and treatment of group G streptococcal bacteremia.
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Affiliation(s)
- Haider Ghazanfar
- BronxCare Health System, Internal Medicine 1650 Selwyn AvenueBronxNew YorkUSA
| | - Zaheer Qureshi
- BronxCare Health System, Internal Medicine 1650 Selwyn AvenueBronxNew YorkUSA
| | - Harika Kalangi
- BronxCare Health System, Internal Medicine 1650 Selwyn AvenueBronxNew YorkUSA
| | - Subhan Ata
- BronxCare Health System, Internal Medicine 1650 Selwyn AvenueBronxNew YorkUSA
| | - Abhilasha Jyala
- BronxCare Health System, Internal Medicine 1650 Selwyn AvenueBronxNew YorkUSA
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Ikebe T, Otsuka H, Chiba K, Kazawa Y, Yamaguchi T, Okuno R, Date Y, Sasaki M, Isobe J, Ohnishi M, Akeda Y. Natural mutation in the regulatory gene (srrG) influences virulence-associated genes and enhances invasiveness in Streptococcus dysgalactiae subsp. equisimilis strains isolated from cases of streptococcal toxic shock syndrome. EBioMedicine 2022; 81:104133. [PMID: 35779495 PMCID: PMC9244731 DOI: 10.1016/j.ebiom.2022.104133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/13/2022] [Accepted: 06/13/2022] [Indexed: 11/25/2022] Open
Abstract
Background Streptococcus dysgalactiae subspecies equisimilis (SDSE) has emerged as an important cause of severe invasive infections including streptococcal toxic shock syndrome (STSS). The present study aimed to identify genes involved in differences in invasiveness between STSS and non-invasive SDSE isolates. Methods STSS and non-invasive SDSE isolates were analysed to identify csrS/csrR mutations, followed by a comparative analysis of genomic sequences to identify mutations in other genes. Mutant strains were generated to examine changes in gene expression profiles and altered pathogenicity in mice. Findings Of the 79 STSS-SDSE clinical isolates, 15 (19.0%) harboured csrS/csrR mutations, while none were found in the non-invasive SDSE isolates. We identified a small RNA (sRNA) that comprised three direct repeats along with an inverted repeat and was transcribed in the same direction as the sagA gene. The sRNA was referred to as srrG (streptolysin S regulatory RNA in GGS). srrG mutations were identified in the STSS-SDSE strains and were found to be associated with elevated expression of the streptolysin S (SLS) gene cluster and enhanced pathogenicity in mice. Interpretation The csrS/csrR and srrG mutations that increased virulence gene expression in STSS-SDSE isolates were identified, and strains carrying these mutations caused increased lethality in mice. A significantly higher frequency of mutations was observed in STSS-SDSE isolates, thereby highlighting their importance in STSS. Funding Japan Agency for Medical Research and Development, the Japan Society for the Promotion of Science (JSPS), and the Ministry of Health, Labor, and Welfare of Japan.
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Affiliation(s)
- Tadayoshi Ikebe
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan.
| | - Hitoshi Otsuka
- Department of Public Health Sciences, Yamaguchi Prefectural Institute of Public Health and Environment, Yamaguchi, Japan
| | - Kazuki Chiba
- Division of Microbiology, Fukushima Prefectural Institute of Public Health, Fukushima, Japan
| | - Yu Kazawa
- Division of Microbiology, Fukushima Prefectural Institute of Public Health, Fukushima, Japan
| | - Takahiro Yamaguchi
- Division of Microbiology, Osaka Institute of Public Health, Osaka, Japan
| | - Rumi Okuno
- Department of Microbiology, Tokyo Metropolitan Institute of Public Health, Tokyo, Japan
| | - Yoshimi Date
- Division of Microbiology, Kanagawa Prefectural Institute of Public Health, Kanagawa, Japan
| | - Mari Sasaki
- Laboratory of Microbiology, Oita Prefectural Institute of Health and Environment, Oita, Japan
| | - Junko Isobe
- Department of Bacteriology, Toyama Institute of Health, Toyama, Japan
| | - Makoto Ohnishi
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yukihiro Akeda
- Department of Bacteriology I, National Institute of Infectious Diseases, Tokyo, Japan
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13
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Jagne I, Keeley AJ, Bojang A, Camara B, Jallow E, Senghore E, Oluwalana C, Bah SY, Turner CE, Sesay AK, D’Alessandro U, Bottomley C, de Silva TI, Roca A. Impact of intra-partum azithromycin on carriage of group A streptococcus in the Gambia: a posthoc analysis of a double-blind randomized placebo-controlled trial. BMC Infect Dis 2022; 22:103. [PMID: 35093029 PMCID: PMC8800276 DOI: 10.1186/s12879-022-07080-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 01/11/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Group A Streptococcus (GAS) is a major human pathogen and an important cause of maternal and neonatal sepsis. Asymptomatic bacterial colonization is considered a necessary step towards sepsis. Intra-partum azithromycin may reduce GAS carriage.
Methods
A posthoc analysis of a double-blind, placebo-controlled randomized-trial was performed to determine the impact of 2 g oral dose of intra-partum azithromycin on maternal and neonatal GAS carriage and antibiotic resistance. Following screening, 829 mothers were randomized who delivered 843 babies. GAS was determined by obtaining samples from the maternal and newborn nasopharynx, maternal vaginal tract and breastmilk. Whole Genome Sequencing (WGS) of GAS isolates was performed using the Illumina Miseq platform.
Results
GAS carriage was lower in the nasopharynx of both mothers and babies and breast milk among participants in the azithromycin arm. No differences in GAS carriage were found between groups in the vaginal tract. The occurrence of azithromycin-resistant GAS was similar in both arms, except for a higher prevalence in the vaginal tract among women in the azithromycin arm. WGS revealed all macrolide-resistant vaginal tract isolates from the azithromycin arm were Streptococcus dysgalactiae subspecies equisimilis expressing Lancefield group A carbohydrate (SDSE(A)) harbouring macrolide resistant genes msr(D) and mef(A). Ten of the 45 GAS isolates (22.2%) were SDSE(A).
Conclusions
Oral intra-partum azithromycin reduced GAS carriage among Gambian mothers and neonates however carriage in the maternal vaginal tract was not affected by the intervention due to azithromycin resistant SDSE(A). SDSE(A) resistance must be closely monitored to fully assess the public health impact of intrapartum azithromycin on GAS.
Trial registration ClinicalTrials.gov Identifier NCT01800942
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14
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Horn DL, Roberts EA, Shen J, Chan JD, Bulger EM, Weiss NS, Lynch JB, Bryson-Cahn C, Robinson BRH. Outcomes of β-Hemolytic Streptococcal Necrotizing Skin and Soft-tissue Infections and the Impact of Clindamycin Resistance. Clin Infect Dis 2021; 73:e4592-e4598. [PMID: 33151283 PMCID: PMC8664434 DOI: 10.1093/cid/ciaa976] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/11/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND β-Hemolytic streptococci are frequently implicated in necrotizing soft-tissue infections (NSTIs). Clindamycin administration may improve outcomes in patients with serious streptococcal infections. However, clindamycin resistance is growing worldwide, and resistance patterns in NSTIs and their impact on outcomes are unknown. METHODS Between 2015 and 2018, patients with NSTI at a quaternary referral center were followed up for the outcomes of death, limb loss, and streptococcal toxic shock syndrome. Surgical wound cultures and resistance data were obtained within 48 hours of admission as part of routine care. Risk ratios for the association between these outcomes and the presence of β-hemolytic streptococci or clindamycin-resistant β-hemolytic streptococci were calculated using log-binomial regression, controlling for age, transfer status, and injection drug use-related etiology. RESULTS Of 445 NSTIs identified, 85% had surgical wound cultures within 48 hours of admission. β-Hemolytic streptococci grew in 31%, and clindamycin resistance was observed in 31% of cultures. The presence of β-hemolytic streptococci was associated with greater risk of amputation (risk ratio, 1.80; 95% confidence interval, 1.07-3.01), as was the presence of clindamycin resistance among β-hemolytic streptococci infections (1.86; 1.10-3.16). CONCLUSIONS β-Hemolytic streptococci are highly prevalent in NSTIs, and in our population clindamycin resistance was more common than previously described. Greater risk of limb loss among patients with β-hemolytic streptococci-particularly clindamycin-resistant strains-may portend a more locally aggressive disease process or may represent preexisting patient characteristics that predispose to both infection and limb loss. Regardless, these findings may inform antibiotic selection and surgical management to maximize the potential for limb salvage.
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Affiliation(s)
- Dara L Horn
- Department of Surgery, University of Washington, Seattle, Washington, USA
| | - Emma A Roberts
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Jolie Shen
- University of Washington School of Medicine, Seattle, Washington, USA
| | - Jeannie D Chan
- Department of Medicine, Divisions of Allergy & Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Eileen M Bulger
- Division of Trauma and Critical Care, Department of Surgery, University of Washington, Harborview Medical Center, Seattle, Washington, USA
| | - Noel S Weiss
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - John B Lynch
- Department of Medicine, Divisions of Allergy & Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Chloe Bryson-Cahn
- Department of Medicine, Divisions of Allergy & Infectious Diseases, University of Washington, Seattle, Washington, USA
| | - Bryce R H Robinson
- Division of Trauma and Critical Care, Department of Surgery, University of Washington, Harborview Medical Center, Seattle, Washington, USA
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15
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Kiefer ZE, Koester LR, Studer JM, Chipman AL, Mainquist-Whigham C, Keating AF, Schmitz-Esser S, Ross JW. Vaginal microbiota differences associated with pelvic organ prolapse risk during late gestation in commercial sows. Biol Reprod 2021; 105:1545-1561. [PMID: 34542158 PMCID: PMC8689292 DOI: 10.1093/biolre/ioab178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/13/2021] [Accepted: 09/14/2021] [Indexed: 12/19/2022] Open
Abstract
During the last decade, sow mortality due to pelvic organ prolapse (POP) has increased. To better understand the biology associated with POP, sows were phenotypically assessed and assigned a perineal score (PS) based on presumed POP risk and categorized as PS1 (low), PS2 (moderate), or PS3 (high). The study objective was to identify changes in sow vaginal microbiota that may be associated with POP. The hypothesis is that vaginal microbiota differs between sows with variable risk for POP, and changes in microbiota during late gestation exist between sows with differing risk. Of the 2864 sows scored during gestation week 15, 1.0, 2.7, and 23.4% of PS1, PS2, and PS3 sows, respectively, subsequently experienced POP. Vaginal swabs subjected to 16S rRNA gene sequencing revealed differences in community composition (Bray–Curtis; P < 0.05) and individual operational taxonomic unit (OTU) comparisons between vaginal microbiota of PS1 and PS3 sows at gestation week 15. Further, differences (P < 0.05) in community composition and OTUs (Q < 0.05) were observed in PS3 sows that either did or did not subsequently experience POP. Differences in community structure (alpha diversity measurements; P < 0.05), composition (P < 0.05), and OTUs (Q < 0.05) were observed in gestation week 12 sows scored PS1 compared to week 15 sows scored PS1 or PS3, suggesting that sow vaginal microbiota shifts during late gestation differently as POP risk changes. Collectively, these data demonstrate that sows with greater POP risk have unique vaginal microflora, for which a better understanding could aid in the development of mitigation strategies.
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Affiliation(s)
- Zoë E Kiefer
- Department of Animal Science, Iowa State University, Ames, Iowa, United States
| | - Lucas R Koester
- Department of Veterinary Microbiology and Preventive Medicine, Iowa State University, Ames, Iowa, United States.,Interdepartmental Microbiology Graduate Program, Iowa State University, Ames, Iowa, United States
| | - Jamie M Studer
- Department of Animal Science, Iowa State University, Ames, Iowa, United States
| | | | | | - Aileen F Keating
- Department of Animal Science, Iowa State University, Ames, Iowa, United States
| | - Stephan Schmitz-Esser
- Department of Animal Science, Iowa State University, Ames, Iowa, United States.,Interdepartmental Microbiology Graduate Program, Iowa State University, Ames, Iowa, United States
| | - Jason W Ross
- Department of Animal Science, Iowa State University, Ames, Iowa, United States.,Iowa Pork Industry Center, Ames, Iowa, United States
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16
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Miles B, Tuomela K, Sanchez J. Severe Group C Streptococcus infection in a veterinarian. IDCases 2021; 23:e01036. [PMID: 33552899 PMCID: PMC7847947 DOI: 10.1016/j.idcr.2020.e01036] [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: 09/06/2020] [Revised: 12/19/2020] [Accepted: 12/21/2020] [Indexed: 12/05/2022] Open
Abstract
Group C Streptococcus (GCS) is part of the normal commensal flora of the upper airway, as well as frequently colonizes the skin, gastrointestinal tract, and female genital tract. It can also be implicated in mono- and polymicrobial infections of the skin and soft tissue, pharyngitis, bacteremia, endocarditis, septic arthritis, osteomyelitis, and meningitis. Our case study features a previously healthy 65-year-old male, who retired as a veterinarian one month prior, with Group C Streptococcus bacteremia complicated by septic polyarthritis, native mitral valve endocarditis, and lumbar discitis/osteomyelitis.
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Affiliation(s)
- Bryan Miles
- Medical College of Wisconsin, 8701 W Watertown Plank Rd, Wauwatosa, WI 53226, United States
| | - Krista Tuomela
- Medical College of Wisconsin, Pediatrics/Internal Medicine Department, 8701 W Watertown Plank Rd, Wauwatosa, WI, 53226, United States
| | - Joyce Sanchez
- Medical College of Wisconsin, Infectious Disease Department, 8701 W Watertown Plank Rd, Wauwatosa, WI, 53226, United States
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17
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Gajdács M, Ábrók M, Lázár A, Burián K. Beta-Haemolytic Group A, C and G Streptococcal Infections in Southern Hungary: A 10-Year Population-Based Retrospective Survey (2008-2017) and a Review of the Literature. Infect Drug Resist 2021; 13:4739-4749. [PMID: 33408489 PMCID: PMC7781025 DOI: 10.2147/idr.s279157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/18/2020] [Indexed: 01/06/2023] Open
Abstract
Introduction Pyogenic β-hemolytic streptococci (including Group A, C and G Streptococcus) are some of the most important Gram-positive bacterial pathogens in human medicine. Although effective therapy is available, invasive streptococcal infections are associated with a significant disease burden. Methods In this retrospective study, the epidemiological characteristics of invasive Group A (iGAS) and Group C and G (iGCGS) streptococci, along with tonsillo-pharyngitis-causing pGAS and pGCGS infections, were assessed in Southern Hungary. A total of 1554 cases of streptococcal tonsillo-pharyngitis infections (26.5–44.1/100,000 persons, pGAS: 95.5%; n=1484) and 1104 cases of invasive streptococcal infections were detected (12.5–31.4/100,000 persons, iGAS: 77.9%; n=861). Results The average age of the affected patients in the various groups were the following: pGAS: 13.2±13.1 years, pGCGS: 21.0±15.0 years (p=0.039), iGAS: 49.1±12.8 years, iGCGS: 58.7±18.5 years (p>0.05). iGAS isolates originated from abscesses (47.1%), blood culture samples (24.1%), surgical samples (16.7%), biopsies (4.6%), pleural fluid (3.5%), pus (2.0%), synovial fluid (1.3%) and cerebrospinal fluid samples (0.7%). In contrast, iGCGS isolates mainly originated from blood culture samples (53.8%), abscesses (22.9%), surgical samples (12.3%), synovial fluid (5.1%), pleural fluid (3.7%), pus (1.8%) and cerebrospinal fluid samples (0.4%). All respective isolates were susceptible to benzyl-penicillin; overall resistance levels for erythromycin (10.5% for GAS, 21.4% for GCGS) and clindamycin (9.2% for GAS, 17.2% for GCGS) were significantly higher in GCGS isolates, while resistance levels for norfloxacin were higher in GAS isolates (13.5% for GAS, 6.9% for GCGS). Conclusion The rates of resistance to macrolides and clindamycin are a cause for concern (especially among GCGS isolates); however, resistance levels are still relatively low, compared to Southern European countries.
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Affiliation(s)
- Márió Gajdács
- Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, Szeged 6720, Hungary
| | - Marianna Ábrók
- Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Andrea Lázár
- Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Katalin Burián
- Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, Szeged, Hungary.,Department of Medical Microbiology, Faculty of Medicine, University of Szeged, Szeged 6720, Hungary
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18
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Rojo-Bezares B, Toca L, Azcona-Gutiérrez JM, Ortega-Unanue N, Toledano P, Sáenz Y. Streptococcus dysgalactiae subsp. equisimilis from invasive and non-invasive infections in Spain: combining epidemiology, molecular characterization, and genetic diversity. Eur J Clin Microbiol Infect Dis 2021; 40:1013-1021. [PMID: 33392783 DOI: 10.1007/s10096-020-04119-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/02/2020] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to characterize the antibiotic resistance, virulence, and genetic diversity among invasive and non-invasive Streptococcus dysgalactiae subsp. equisimilis (SDSE) isolates. SDSE were isolated from clinical samples of outpatients and inpatients cares in La Rioja region (Spain) during 2012-2015. The analyses performed were susceptibility testing by disc diffusion, resistance and virulence genes by PCR, emm typing by PCR and sequencing, and other molecular typing by SmaI-PFGE and MLST. Forty-two SDSE isolates were recovered (64.3% non-invasive, 35.7% invasive) that were grouped in 31 PFGE patterns, 17 ST, and 14 emm types, being stC1400, stG6792, and stG62647 the most frequent, and stC74a and stC5345 exclusive in invasive SDSE. Twenty-one SDSE were resistant to at least one antibiotic. The erm(TR) and erm(B) genes were linked with resistance to macrolides; tet(M) and tet(T) to tetracycline; dfrF to trimethoprim; ant(6)-Ia and aph(3')-IIIa to aminoglycosides; and the substitutions Asp80Ala in GyrA and Ser79Phe in ParC with resistance to levofloxacin. The sagA, slo, scpA, and ska virulence genes were amplified in 93% SDSE. Streptococcal superantigenic speGdys gene was identified in 80% of invasive and 63% of non-invasive SDSE and correlated with certain emm types (e.g., stG62647 or stG6792). SDSE invasive infections were most frequent in elderly patients, and half of our SDSE were resistant to at least one antibiotic tested. This work is the first detection of tet(T), dfrF, and new substitution in GyrA protein in SDSE. A high diversity of circulating genetic lineages was found among our SDSE.
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Affiliation(s)
- Beatriz Rojo-Bezares
- Área de Microbiología Molecular, Centro de Investigación Biomédica de La Rioja (CIBIR), Piqueras Street, n° 98, 26006, Logroño, Spain.
| | - Laura Toca
- Área de Microbiología Molecular, Centro de Investigación Biomédica de La Rioja (CIBIR), Piqueras Street, n° 98, 26006, Logroño, Spain
| | | | - Nerea Ortega-Unanue
- Departamento de Diagnóstico Biomédico, Laboratorio de Análisis Clínicos, Hospital San Pedro, Logroño, Spain
- Unidad de Genética, Hospital Universitario Donostia, San Sebastian, Spain
| | - Paula Toledano
- Área de Microbiología Molecular, Centro de Investigación Biomédica de La Rioja (CIBIR), Piqueras Street, n° 98, 26006, Logroño, Spain
| | - Yolanda Sáenz
- Área de Microbiología Molecular, Centro de Investigación Biomédica de La Rioja (CIBIR), Piqueras Street, n° 98, 26006, Logroño, Spain
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19
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Oh SI, Kim JW, Kim J, So B, Kim B, Kim HY. Molecular subtyping and antimicrobial susceptibility of Streptococcus dysgalactiae subspecies equisimilis isolates from clinically diseased pigs. J Vet Sci 2020; 21:e57. [PMID: 32735095 PMCID: PMC7402932 DOI: 10.4142/jvs.2020.21.e57] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/13/2020] [Accepted: 04/16/2020] [Indexed: 11/30/2022] Open
Abstract
Background Streptococcus dysgalactiae subspecies equisimilis (SDSE) acts as an etiological agent for lameness, neurological signs, and high mortality in pigs. Despite its importance in pig industries and zoonotic potential, little is known about the effects of this pathogen. Objectives This study aimed to determine the molecular characteristics and antimicrobial resistance of SDSE strains isolated from diseased pigs. Methods A total 11 SDSE isolates were obtained from diseased pigs. Bacterial identification, PCR for virulence genes, emm typing, and antimicrobial resistance genes, multilocus sequence typing, and antimicrobial susceptibility test were performed. Results Nine isolates were from piglets, and 8 showed lameness, sudden death, or neurological signs. The isolates were PCR-positive for sla (100%), sagA (100%), and scpA (45.5%), and only 1 isolate amplified the emm gene (stL2764). Eight different sequence types were detected, categorized into 2 clonal complexes and 4 singletons. All the isolates in this study were included in a small cluster, which also contained other strains derived from humans and horses. The minimum inhibitory concentrations for the tested beta-lactams were low, while those for macrolides, tetracyclines, and fluoroquinolones were relatively high. PCR analysis of the macrolide and tetracycline resistance genes demonstrated that the isolates carried erm(B) (18.2%, n = 2), mef(A/E) (9.1%, n = 1), tet(M) (18.2%, n = 2), and tet(O) (90.2%, n = 10). Two isolates presented a mutation in parC, which is associated with fluoroquinolone resistance. Conclusion This study provided insight into swine-derived SDSE, as it is related to veterinary medicine, and elucidated its zoonotic potential, in the context of molecular epidemiology and antimicrobial resistance in public health.
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Affiliation(s)
- Sang Ik Oh
- Animal Disease Diagnostic Division, Animal and Plant Quarantine Agency, Gimcheon 39660, Korea.,College of Veterinary Medicine, Jeonbuk National University, Iksan 54596, Korea
| | - Jong Wan Kim
- Animal Disease Diagnostic Division, Animal and Plant Quarantine Agency, Gimcheon 39660, Korea
| | - Jongho Kim
- Animal Disease Diagnostic Division, Animal and Plant Quarantine Agency, Gimcheon 39660, Korea
| | - Byungjae So
- Animal Disease Diagnostic Division, Animal and Plant Quarantine Agency, Gimcheon 39660, Korea
| | - Bumseok Kim
- College of Veterinary Medicine, Jeonbuk National University, Iksan 54596, Korea
| | - Ha Young Kim
- Animal Disease Diagnostic Division, Animal and Plant Quarantine Agency, Gimcheon 39660, Korea.
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20
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Hasegawa T, Matsumoto M, Hata N, Yano H, Isaka M, Tatsuno I. Homologous role of CovRS two-component regulatory system in NAD+-glycohydrolase activity inStreptococcus dysgalactiaesubsp.equisimilisas inStreptococcus pyogenes. APMIS 2019; 127:87-92. [DOI: 10.1111/apm.12914] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 11/26/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Tadao Hasegawa
- Department of Bacteriology; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
| | - Masakado Matsumoto
- Department of Microbiology and Medical Zoology; Aichi Prefectural Institute of Public Health; Nagoya Japan
| | - Nanako Hata
- Department of Microbiology; Nagoya City University Hospital; Nagoya Japan
| | - Hisako Yano
- Department of Infection Control and Prevention Nursing; Nagoya City University Graduate School of Nursing; Nagoya Japan
| | - Masanori Isaka
- Department of Bacteriology; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
| | - Ichiro Tatsuno
- Department of Bacteriology; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
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21
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Ogura K, Okumura K, Shimizu Y, Kirikae T, Miyoshi-Akiyama T. Pathogenicity Induced by Invasive Infection of Streptococcus dysgalactiae subsp. equisimilis in a Mouse Model of Diabetes. Front Microbiol 2018; 9:2128. [PMID: 30298057 PMCID: PMC6160533 DOI: 10.3389/fmicb.2018.02128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/20/2018] [Indexed: 11/13/2022] Open
Abstract
Streptococcus dysgalactiae subsp. equisimilis (SDSE) causes severe invasive diseases such as streptococcal toxic shock syndrome, similar to that caused by S. pyogenes (GAS). Invasive SDSE infections are increasing, particularly among patients with diabetes mellitus. Here we investigate the association between the pathogenicity of SDSE and diabetes mellitus in a mouse model, using GAS infection for comparison. Intraperitoneal injection of highly hemolytic SDSE-167 into C57BL6/J mice induced a rapid rise in blood glucose concentrations within 4 h, which was otherwise seen only in mice injected with high doses of hypervirulent GAS mutants. The survival rates of mice injected with SDSE-167 were significantly lower in mice (db/db) with type 2 diabetes than in nondiabetic mice. Injection of db/db mice with SDSE-167 increased the concentrations of cytokines and chemokines, particularly those of interleukin 6 and monocyte chemotactic protein-1. Microarray data indicate that multiple pathways are involved in the pathogenicity of SDSE-167 in db/db mice. These data reveal that the mechanisms underlying streptococcal infection differ between SDSE and GAS.
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Affiliation(s)
- Kohei Ogura
- Pathogenic Microbe Laboratory, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.,Advanced Health Care Science Research Unit, Institute for Frontier Science Initiative, Ishikawa, Japan
| | - Kayo Okumura
- Department of Infectious Disease, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yukiko Shimizu
- Department of Infectious Disease, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
| | - Teruo Kirikae
- Department of Infectious Disease, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.,Department of Microbiology, Juntendo University School of Medicine, Tokyo, Japan
| | - Tohru Miyoshi-Akiyama
- Pathogenic Microbe Laboratory, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan
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22
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Gupta A, Tsui E, Sarrafpour S, Lee CM, Modi YS. Streptococcus Dysgalactiae Subspecies Equisimilis Endogenous Endophthalmitis Associated with Aortic Valve Abscess. Ocul Immunol Inflamm 2018; 27:743-746. [PMID: 29969334 DOI: 10.1080/09273948.2018.1489062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: To describe a case of endogenous endophthalmitis from Streptococcus dysgalactiae subspecies equisimilis in the setting of an aortic valve abscess Methods: Retrospective case report. Results: A 72-year-old white male presented with fevers, encephalopathy, and decreased vision in his left eye. His visual acuity was 20/20 in his right eye and finger counting in the left eye. Workup revealed an aortic valve abscess. Examination of his left eye revealed dense anterior chamber fibrin and no view of the retina. B-scan ultrasonography revealed loculated hyperechoic areas consistent with vitreous inflammation. A vitreous tap and injections with vancomycin and ceftazidime were performed. Visual acuity worsened to no-light perception 5 days later. Vitreous and blood cultures grew Streptococcus dysgalactiae subspecies equisimilis. He received another intravitreal injection of vancomycin with no improvement. Conclusions: Streptococcus dysgalactiae subspecies equisimilis is an emerging pathogen and may cause severe intraocular infections with a poor visual outcome.
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Affiliation(s)
- Akash Gupta
- a Department of Ophthalmology, New York University School of Medicine , New York , New York , USA
| | - Edmund Tsui
- a Department of Ophthalmology, New York University School of Medicine , New York , New York , USA
| | - Soshian Sarrafpour
- a Department of Ophthalmology, New York University School of Medicine , New York , New York , USA
| | - Carol M Lee
- a Department of Ophthalmology, New York University School of Medicine , New York , New York , USA
| | - Yasha S Modi
- a Department of Ophthalmology, New York University School of Medicine , New York , New York , USA
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23
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Hagiya H, Semba T, Morimoto T, Yamamoto N, Yoshida H, Tomono K. Panophthalmitis caused by Streptococcus dysgalactiae subsp. equisimilis: A case report and literature review. J Infect Chemother 2018; 24:936-940. [PMID: 29752197 DOI: 10.1016/j.jiac.2018.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 04/10/2018] [Accepted: 04/17/2018] [Indexed: 11/19/2022]
Abstract
Lancefield group G β-hemolytic Streptococcus dysgalactiae subspecies equisimilis (SDSE) has become a leading causative pathogen of invasive streptococcal infection. In this report, we describe a case of disseminated SDSE infection complicated by endogenous endophthalmitis, resulting in panophthalmitis and blindness. A 65-year-old man who underwent mitral valve replacement surgery two months previously was hospitalized due to high fever and right visual loss. A systemic investigation revealed endophthalmitis complicated by mediastinal abscess, prosthetic infective endocarditis, cerebral emboli and hemorrhage, and multiple arthritis. The patient underwent various surgeries, including vitrectomy, mediastinal lavage, mitral valve replacements, joint lavages, as well as an intensive antibiotic treatment. His general condition gradually improved, but the ocular infection developed to panophthalmitis, which ultimately required ophthalmectomy. A literature review regarding Group G-associated endogenous endophthalmitis suggested that the disease occurs in elderly people, is frequently complicated with endocarditis, and yields poor visual prognosis regardless of appropriate antibiotic treatment and surgical therapies. In this aging society, invasive infections with SDSE should be much more recognized among medical practitioners in order to improve patient prognosis.
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Affiliation(s)
- Hideharu Hagiya
- Division of Infection Control and Prevention, Osaka University Hospital, Japan.
| | - Takuya Semba
- Department of Ophthalmology, Osaka University Hospital, Japan
| | | | - Norihisa Yamamoto
- Division of Infection Control and Prevention, Osaka University Hospital, Japan
| | - Hisao Yoshida
- Division of Infection Control and Prevention, Osaka University Hospital, Japan
| | - Kazunori Tomono
- Division of Infection Control and Prevention, Osaka University Hospital, Japan
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Kim S, Byun JH, Park H, Lee J, Lee HS, Yoshida H, Shibayama A, Fujita T, Tsuyuki Y, Takahashi T. Molecular Epidemiological Features and Antibiotic Susceptibility Patterns of Streptococcus dysgalactiae subsp. equisimilis Isolates from Korea and Japan. Ann Lab Med 2018; 38:212-219. [PMID: 29401555 PMCID: PMC5820065 DOI: 10.3343/alm.2018.38.3.212] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/02/2017] [Accepted: 01/05/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The molecular characterization of Streptococcus dysgalactiae subsp. equisimilis (SDSE) has not yet been performed in Korea. This study aimed to find the differences or similarities in the clinical features, molecular epidemiological findings, and antimicrobial resistance patterns of SDSE from two countries (Korea and Japan). METHODS SDSE isolates were collected from Korea (N=69) from 2012-2016 and Japan (N=71) from 2014-2016. Clinical characteristics, emm genotypes, and sequence types (STs) were compared. Microdilution tests were performed using different antimicrobials, and their resistance determinants were screened. RESULTS Median ages were 69 years in Korea and 76 years in Japan. The most common underlying diseases were diabetes and malignancy. Blood-derived isolates comprised 36.2% and 50.7% of Korean and Japanese isolates, respectively; mortality was not different between the two groups (5.8% vs 9.9%, P=0.53). Among Korean isolates with 20 different combined ST-emm types, ST127-stG245 (N=16), ST128-stG485 (N=10), and ST138-stG652 (N=8) were prevalent. Among Japanese isolates with 29 different combined types, ST17-stG6792 (N=11), ST29-stG485 (N=7), and ST205-stG6792 (N=6) were prevalent. Resistance rates to erythromycin, clindamycin, and minocycline were 34.8%, 17.4%, and 30.4% in Korea and 28.2%, 14.1%, and 21.4% in Japan, respectively. CONCLUSIONS SDSE infections commonly occurred in elderly persons with underlying diseases. There was a significant difference in the distribution of ST-emm types between the two countries. Antimicrobial resistance rates were comparable with different frequencies of resistance determinants in each country.
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Affiliation(s)
- Sunjoo Kim
- Department of Laboratory Medicine, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Jung Hyun Byun
- Department of Laboratory Medicine, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Hyunwoong Park
- Department of Laboratory Medicine, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Jaehyeon Lee
- Department of Laboratory Medicine, Chonbuk National University School of Medicine, Jeonju, Korea
| | - Hye Soo Lee
- Department of Laboratory Medicine, Chonbuk National University School of Medicine, Jeonju, Korea
| | - Haruno Yoshida
- Laboratory of Infectious Diseases, Kitasato Institute for Life Sciences, Kitasato University, Tokyo, Japan
| | - Akiyoshi Shibayama
- Laboratory of Infectious Diseases, Kitasato Institute for Life Sciences, Kitasato University, Tokyo, Japan
| | - Tomohiro Fujita
- Laboratory of Infectious Diseases, Kitasato Institute for Life Sciences, Kitasato University, Tokyo, Japan
| | - Yuzo Tsuyuki
- Laboratory of Infectious Diseases, Kitasato Institute for Life Sciences, Kitasato University, Tokyo, Japan
| | - Takashi Takahashi
- Laboratory of Infectious Diseases, Kitasato Institute for Life Sciences, Kitasato University, Tokyo, Japan.
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Saintot C, André J, Hentgen C, Jacques L, Barrans A. Meningitis and septic shock caused by Streptococcus dysgalactiae subsp. equisimilis. Med Mal Infect 2018; 48:221-222. [DOI: 10.1016/j.medmal.2017.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 12/12/2017] [Indexed: 11/16/2022]
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Kotora JG, Schmieler EJ, McEvoy CS, Noble SL. Group C strep mediastinitis. Am J Emerg Med 2018; 36:907.e5-907.e9. [PMID: 29454509 DOI: 10.1016/j.ajem.2018.01.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 01/23/2018] [Indexed: 11/18/2022] Open
Abstract
This case is significant to the practice of emergency medicine because it represents the development of an uncommon and potentially fatal mediastinal infection from a commonly encountered and appropriately treated community respiratory pathogen. Most published reports on mediastinitis are those that are status-post cardiothoracic surgery. In our report, we discuss a case of a healthy, young individual who developed this morbid entity from extension of a simple respiratory infection where Group C Streptococcus has been isolated as the causative organism, which to our knowledge has not been previously reported. Further, this report outlines how a community acquired pneumonia progressed to a life threatening illness despite proper initial treatment per local and national guidelines.
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Affiliation(s)
| | | | | | - Stephen L Noble
- 620 John Paul Jones Circle, Portsmouth VA 23708, United States.
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Molecular characterization and antibiotic resistance of Streptococcus dysgalactiae subspecies equisimilis isolated from patients with streptococcal toxic shock syndrome. J Infect Chemother 2017; 24:117-122. [PMID: 29107650 DOI: 10.1016/j.jiac.2017.09.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 09/27/2017] [Accepted: 09/28/2017] [Indexed: 11/23/2022]
Abstract
Streptococcal toxic shock syndrome (STSS) is a severe invasive infection characterized by the sudden onset of shock, multiorgan failure, and high mortality. Although STSS is mainly caused by Streptococcus pyogenes, group G streptococcus identified as S. dysgalactiae subsp. equisimilis (SDSE) causing STSS has also been reported; however, no study has analyzed >100 isolates of SDSE causing STSS. Therefore, we characterized the emm genotype of 173 SDSE isolates obtained from STSS patients in Japan during 2014-2016 and performed antimicrobial susceptibility testing using the broth microdilution method and emm gene typing. The predominant emm genotype was found to be stG6792, followed by stG485, stG245, stG10, stG6, and stG2078. These six genotypes constituted more than 75% of the STSS isolates. The proportion of each emm genotype in STSS isolates correlated with that in invasive isolates previously reported. We found that 16.2% of the isolates showed clindamycin resistance. The proportion of clindamycin-resistant SDSE isolates was significantly higher than that of S. pyogenes isolates. Thus, while treating STSS caused by SDSE, it is necessary to consider the possibility of clindamycin resistance and to ensure judicious use of the drug.
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Lother SA, Jassal DS, Lagacé-Wiens P, Keynan Y. Emerging group C and group G streptococcal endocarditis: A Canadian perspective. Int J Infect Dis 2017; 65:128-132. [PMID: 29097247 DOI: 10.1016/j.ijid.2017.10.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/22/2017] [Accepted: 10/23/2017] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The aim of this study was to determine the incidence of infective endocarditis (IE) in patients with bacteremia caused by group C and group G streptococci (GCGS) and to characterize the burden of disease, clinical characteristics, and outcomes through a case series of patients with GCGS IE. METHODS Individuals with blood cultures growing GCGS in Manitoba, Canada, between January 2012 and December 2015 were included. Clinical and echocardiographic parameters were collected retrospectively. IE was suspected or confirmed according to the modified Duke criteria. RESULTS Two hundred and nine bacteremic events occurred in 198 patients. Transthoracic echocardiography (TTE) was performed in 33%. Suspected or confirmed IE occurred in 6% of all patients and in 18% of those with TTE. Native valve infection was more common than prosthetic valve and device-related infections (75%, 17%, and 8%, respectively). Metastatic infection was observed in 64%, primarily to the lungs (57%), skin (43%), osteoarticular system (29%), and central nervous system (29%). Sepsis occurred in 58% and streptococcal toxic shock syndrome in 50% of those with IE, with overall mortality of 17%. CONCLUSIONS IE from GCGS bacteremia is common and is frequently associated with severe disease, embolic events, and mortality. In the appropriate clinical context, GCGS bacteremic events should prompt investigation for IE.
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Affiliation(s)
- Sylvain A Lother
- Section of Internal Medicine, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, BMSB 507, Department of Medical Microbiology, 745 Bannatyne Ave, Winnipeg, Manitoba R3E0J9, Canada.
| | - Davinder S Jassal
- Section of Cardiology, Department of Internal Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, St. Boniface General Hospital, 409 Taché Avenue, Winnipeg, Manitoba R2H2A6, Canada.
| | - Philippe Lagacé-Wiens
- Department of Medical Microbiology, University of Manitoba and Diagnostic Services Manitoba, L4025, 409 Taché Avenue, Winnipeg, Manitoba R2H2A6, Canada.
| | - Yoav Keynan
- Section of Infectious Diseases, Departments of Internal Medicine, Medical Microbiology, and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, BMSB 507, Department of Medical Microbiology, 745 Bannatyne Ave, Winnipeg, Manitoba R3E0J9, Canada.
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Pocinho RM, Antunes L, Pires P, Baptista I. Multifocal septic arthritis, gluteal abscess and spondylodiscitis by Streptococcus dysgalactiae subspecies equisimilis after an intramuscular injection. BMJ Case Rep 2017; 2017:bcr-2017-220336. [PMID: 28724597 PMCID: PMC5535059 DOI: 10.1136/bcr-2017-220336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2017] [Indexed: 11/04/2022] Open
Abstract
We present the case of a 63-year-old man, admitted for hand cellulitis and acute kidney injury. A Streptococcus dysgalactiae subsp equisimilis (SDSE) was isolated in blood cultures and despite directed intravenous antibiotherapy, the patient evolved unfavourably, with dorsolumbar spondylodiscitis, multifocal septic arthritis and abscesses. CT also showed densification of the gluteal muscles, multiple air bubbles in the psoas, paraspinal muscles and spinal canal that were associated with an intramuscular injection administered 1 week earlier for a backache. After escalation of the antibiotherapy and intensive supportive measures, the patient showed improvement and was discharged after 8 weeks of antibiotherapy.The incidence of invasive SDSE infections has been growing, especially in immunosupressed patients. In this case, despite no predisposing factor identified, it evolved to severe sepsis. The intramuscular injection, a trivialised but not harmless procedure, was the assumed port of entry, as previously described in another case report.
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Affiliation(s)
- Rita Marques Pocinho
- Department of Medicina 1.2, Hospital de São José, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Liliana Antunes
- Department of Medicina 1.2, Hospital de São José, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Pedro Pires
- Department of Medicina 1.2, Hospital de São José, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Isabel Baptista
- Department of Medicina 1.2, Hospital de São José, Centro Hospitalar Lisboa Central, Lisboa, Portugal
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Species and emm-type distribution of group C and G streptococci from different sites of isolation. Diagn Microbiol Infect Dis 2016; 86:467-469. [DOI: 10.1016/j.diagmicrobio.2016.09.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 08/31/2016] [Accepted: 09/12/2016] [Indexed: 11/22/2022]
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Wajima T, Morozumi M, Hanada S, Sunaoshi K, Chiba N, Iwata S, Ubukata K. Molecular Characterization of Invasive Streptococcus dysgalactiae subsp. equisimilis, Japan. Emerg Infect Dis 2016; 22:247-54. [PMID: 26760778 PMCID: PMC4734521 DOI: 10.3201/eid2202.141732] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We collected β-hemolytic streptococci (1,611 isolates) from patients with invasive streptococcal infections in Japan during April 2010-March 2013. Streptococcus dysgalactiae subsp. equisimilis (SDSE) was most common (n = 693); 99% of patients with SDSE infections were elderly (mean age 75 years, SD ±15 years). We aimed to clarify molecular and epidemiologic characteristics of SDSE isolates and features of patient infections. Bacteremia with no identified focus of origin and cellulitis were the most prevalent manifestations; otherwise, clinical manifestations resembled those of S. pyogenes infections. Clinical manifestations also differed by patient's age. SDSE isolates were classified into 34 emm types; stG6792 was most prevalent (27.1%), followed by stG485 and stG245. Mortality rates did not differ according to emm types. Multilocus sequence typing identified 46 sequence types and 12 novel types. Types possessing macrolide- and quinolone-resistance genes were 18.4% and 2.6%, respectively; none showed β-lactam resistance. Among aging populations, invasive SDSE infections are an increasing risk.
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Beta-hemolytic Streptococcus dysgalactiae strains isolated from horses are a genetically distinct population within the Streptococcus dysgalactiae taxon. Sci Rep 2016; 6:31736. [PMID: 27530432 PMCID: PMC4987641 DOI: 10.1038/srep31736] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 07/25/2016] [Indexed: 11/08/2022] Open
Abstract
The pathogenic role of beta-hemolytic Streptococcus dysgalactiae in the equine host is increasingly recognized. A collection of 108 Lancefield group C (n = 96) or L (n = 12) horse isolates recovered in the United States and in three European countries presented multilocus sequence typing (MLST) alleles, sequence types and emm types (only 56% of the isolates could be emm typed) that were, with few exceptions, distinct from those previously found in human Streptococcus dysgalactiae subsp. equisimilis. Characterization of a subset of horse isolates by multilocus sequence analysis (MLSA) and 16S rRNA gene sequence showed that most equine isolates could also be differentiated from S. dysgalactiae strains from other animal species, supporting the existence of a horse specific genomovar. Draft genome information confirms the distinctiveness of the horse genomovar and indicates the presence of potentially horse-specific virulence factors. While this genomovar represents most of the isolates recovered from horses, a smaller MLST and MLSA defined sub-population seems to be able to cause infections in horses, other animals and humans, indicating that transmission between hosts of strains belonging to this group may occur.
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Midha M, Rosenthal ME. Group G streptococcal myositis in a patient with myeloproliferative neoplasm. IDCases 2016; 5:54-6. [PMID: 27500083 PMCID: PMC4971150 DOI: 10.1016/j.idcr.2016.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 07/12/2016] [Accepted: 07/12/2016] [Indexed: 12/05/2022] Open
Abstract
While many cases of streptococcal infection are due to Lancefield groups A and B, there has been a rise in reported cases of infections due to group G streptococcus. We present a case of an individual with a hematologic malignancy who developed myositis secondary to group G streptococcus, with no clearly identifiable source of infection. The patient was managed with antibiotic therapy rather than surgical intervention due to high surgical risk related to severe thrombocytopenia. Targeted antibiotics initiated early in the course of disease may prevent the need for surgical intervention. Early diagnosis and treatment are critical to avoid the high morbidity and mortality of life-threatening infections caused by group G streptococcus.
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Affiliation(s)
- Monica Midha
- Department of Medicine, Jersey Shore University Medical Center, 1945 State Route 33, Neptune, NJ, 07753, United States
| | - Marnie E Rosenthal
- Division of Infectious Diseases, Jersey Shore University Medical Center, 1945 State Route 33, Neptune, NJ, 07753, United States
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Point-Counterpoint: A Nucleic Acid Amplification Test for Streptococcus pyogenes Should Replace Antigen Detection and Culture for Detection of Bacterial Pharyngitis. J Clin Microbiol 2016; 54:2413-9. [PMID: 27440817 DOI: 10.1128/jcm.01472-16] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Nucleic acid amplification tests (NAATs) have frequently been the standard diagnostic approach when specific infectious agents are sought in a clinic specimen. They can be applied for specific agents such as S. pyogenes, or commercial multiplex NAATs for detection of a variety of pathogens in gastrointestinal, bloodstream, and respiratory infections may be used. NAATs are both rapid and sensitive. For many years, S. pyogenes testing algorithms used a rapid and specific group A streptococcal antigen test to screen throat specimens, followed, in some clinical settings, by a throat culture for S. pyogenes to increase the sensitivity of its detection. Now S. pyogenes NAATs are being used with increasing frequency. Given their accuracy, rapidity, and ease of use, should they replace antigen detection and culture for the detection of bacterial pharyngitis? Bobbi Pritt and Robin Patel of the Mayo Clinic, where S. pyogenes NAATs have been used for well over a decade with great success, will explain the advantages of this approach, while Richard (Tom) Thomson and Tom Kirn of the NorthShore University HealthSystem will discuss their concerns about this approach to diagnosing bacterial pharyngitis.
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de Souza JP, Santos AR, de Paula GR, Barros RR. Antimicrobial susceptibility and genetic relationships among Streptococcus dysgalactiae subsp. equisimilis isolates in Rio de Janeiro. Infect Dis (Lond) 2016; 48:676-81. [PMID: 27301015 DOI: 10.1080/23744235.2016.1192680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Streptococcus dysgalactiae subsp. equisimilis (SDSE) has been increasingly associated with several infectious diseases, ranging from pharyngitis to life-threatening conditions, such as necrotizing fasciitis and streptococcal toxic shock syndrome. However, its molecular epidemiology in some geographical areas remains unclear. METHODS In this study, 44 isolates of SDSE, recovered from noninvasive infections (37) and from carriage (7), during 2008-2013, were submitted to antimicrobial susceptibility testing, emm typing and pulsed-field gel electrophoresis (PFGE) analysis. RESULTS All isolates were susceptible to ceftriaxone, levofloxacin, penicillin G and vancomycin. Resistance rates to erythromycin was 18.2% and to clindamycin was 6.8%, while 38.7% of the isolates were tetracycline non-susceptible. Macrolide resistance phenotypes were M (5 isolates), iMLSB (2) and cMLSB (1), associated with mefA/E, ermA and ermB genotypes, respectively. Seventeen emm types with 21 subtypes were found, but 6 types (stG653.0, stC1400.0 with three subtypes, stC839.0, stC36.0 with two subtypes, stG480.0 and stG840.0) were detected in 70.4% of the isolates. Six new emm subtypes were identified (stC1400.12, stC1400.13, emm152.1, emm152.2, stG652.6 and stG6792.5). Twenty-five PFGE profiles were obtained from 39 isolates. CONCLUSIONS Congruence between both typing systems was observed, since the majority of isolates belonging to a given emm type clustered together by PFGE. Clones (at least 80% similarity) were also observed among isolates with different emm types, probably due to horizontal recombination of the emm gene. Erythromycin-resistant isolates harbored diverse emm genes and generated different PFGE profiles, showing a polyclonal dissemination of such characteristic among SDSE isolates.
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Affiliation(s)
- José Paulo de Souza
- a Departmento de Microbiologia e Parasitologia , Instituto Biomédico, Universidade Federal Fluminense , Niterói , Brazil
| | - Amanda Ribeiro Santos
- a Departmento de Microbiologia e Parasitologia , Instituto Biomédico, Universidade Federal Fluminense , Niterói , Brazil
| | | | - Rosana Rocha Barros
- a Departmento de Microbiologia e Parasitologia , Instituto Biomédico, Universidade Federal Fluminense , Niterói , Brazil
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Fujita T, Horiuchi A, Ogawa M, Yoshida H, Hirose Y, Nagano N, Takahashi T. Genetic Diversity in Streptococcus dysgalactiae subsp. equisimilis Isolates from Patients with Invasive and Noninvasive Infections in a Japanese University Hospital (2014-2015). Jpn J Infect Dis 2016; 70:100-104. [PMID: 27000456 DOI: 10.7883/yoken.jjid.2015.602] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Streptococcus dysgalactiae subsp. equisimilis (SDSE) isolates with β-hemolysis and carbohydrate groups G or C are increasingly recovered from invasive infections in Japan. The aim of this study was to determine the epidemiological characteristics of SDSE isolates circulating locally among patients with invasive and noninvasive infections. We selected groups G/C β-hemolytic streptococci from a repository at the Clinical Laboratory of Kitasato University Medical Center, from May 2014 through April 2015. Thirteen isolates were identified as SDSE based on the data from API-20 Strep and 16S rRNA sequencing. The samples were from 7 sterile specimens (blood) and 6 non-sterile specimens (pus/sputum/vaginal secretion). Information about the patients with invasive or noninvasive SDSE infections was retrieved from their medical charts. We performed emm genotyping, multilocus sequence typing, a dendrogram analysis of the samples using pulsed-field gel electrophoresis (PFGE), and amplifications of the streptococcal inhibitor of a complement-mediated cell lysis-like gene (sicG) and antimicrobial resistance determinants. We identified 8 different emm genotypes, 8 different sequence types, including 4 novel types, 9 different groups in the PFGE dendrogram, the presence or absence of sicG, and 4 different resistance genotypes. Our observations indicate genetic diversity in SDSE isolates from patients with invasive and noninvasive infections in a Japanese university hospital (2014-2015).
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Affiliation(s)
- Tomohiro Fujita
- Department of Infection Control and Prevention, Kitasato University Medical Center
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Lu B, Fang Y, Huang L, Diao B, Du X, Kan B, Cui Y, Zhu F, Li D, Wang D. Molecular characterization and antibiotic resistance of clinical Streptococcus dysgalactiae subsp. equisimilis in Beijing, China. INFECTION GENETICS AND EVOLUTION 2016; 40:119-125. [PMID: 26925701 DOI: 10.1016/j.meegid.2016.01.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 01/14/2016] [Accepted: 01/31/2016] [Indexed: 10/22/2022]
Abstract
Streptococcus dysgalactiae subsp. equisimilis (SDSE) is presently considered as a human pathogen associated with clinical infection. We characterized 56 SDSE isolates collected from two tertiary hospitals in Beijing, China. Sixteen distinct emm types/subtypes were detected, dominated by stG245.0 (32.1%), stG652.0 (10.7%), stG6.1 (10.7%) and stG485.0 (10.7%), and a novel stG840.0 variant type was identified. All isolates possessed virulence genes of sagA and scpA, and most carried slo (98.2%), ska (98.2%) and speG(dys) (35.7%). By multilocus sequence typing (MLST) analysis, 17 individual sequence types (STs) were distinguished, including 7 newly-identified STs (26.8% of isolates), of which ST127 (30.4%), ST7 (12.5%) and ST44 (10.7%) dominated. Meanwhile, pulsed-field gel electrophoresis (PFGE) analysis revealed 33 pattern types (PTs), which were further combined into 16 pattern clusters (PCs), and 59.3% of isolates were distributed into 2 dominant PCs. Notably, emm types had both close relationship and consistency with STs and PFGE PCs. Furthermore, of 56 SDSE isolates, the predominant antibiotic resistances were erythromycin (71.4%), clindamycin (71.4%) and tetracycline (60.7%). Correspondingly, the prevalent resistance genes of macrolide and tetracycline were erm(B) (78.6%) and tet(M) (73.2%). In addition, multiple point mutations of parC, one of fluoroquinolone resistance genes, were observed (accounting for 75%), and were divided into 12 types, with parC 07 as the predominant type. Our data suggested the wide molecular diversity and distinctive regional features of SDSE from clinical infection in Beijing, China.
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Affiliation(s)
- Binghuai Lu
- Department of Laboratory Medicine, Civil Aviation General Hospital, Beijing 100123, China.
| | - Yujie Fang
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou 310003, China
| | - Lei Huang
- Department of Laboratory Medicine, First Hospital, Peking University, Beijing 100034, China
| | - Baowei Diao
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou 310003, China
| | - Xiaoli Du
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou 310003, China
| | - Biao Kan
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou 310003, China
| | - Yanchao Cui
- Department of Laboratory Medicine, Civil Aviation General Hospital, Beijing 100123, China
| | - Fengxia Zhu
- Department of Laboratory Medicine, Civil Aviation General Hospital, Beijing 100123, China
| | - Dong Li
- Department of Laboratory Medicine, Civil Aviation General Hospital, Beijing 100123, China
| | - Duochun Wang
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou 310003, China.
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Yoshida H, Takahashi T, Nakamura M, Øverby A, Takahashi T, Ubukata K, Matsui H. A highly susceptible CD46 transgenic mouse model of subcutaneous infection with Streptococcus dysgalactiae subspecies equisimilis. J Infect Chemother 2016; 22:229-34. [PMID: 26908231 DOI: 10.1016/j.jiac.2016.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 12/21/2015] [Accepted: 01/04/2016] [Indexed: 11/29/2022]
Abstract
The Streptococcus dysgalactiae subspecies equisimilis (SDSE) possesses clinical similarities to group A streptococcus (GAS) and has recently been recognized as a causative pathogen of life-threatening streptococcal infections. Human membrane cofactor protein (CD46), a complement regulatory protein ubiquitously expressed on every cell type except for erythrocytes, has been implicated as a receptor for human-specific pathogens including GAS. In the present report, SDSE strain GGS_124 was isolated from a patient suffering from streptococcal toxic shock syndrome. When CD46-expressing transgenic (Tg) and non-Tg mice were infected subcutaneously into a hind footpad with 1 × 10(7) colony-forming units of GGS_124, both CD46 Tg and non-Tg mice showed similar levels of colonization in the popliteal lymph nodes at day 3 after infection. However, the following differences were found between CD46 Tg and non-Tg mice after infection. First, there was a statistically significant difference in mortality rates between CD46 Tg (33%) and non-Tg (0%) mice within 35 days after infection. Second, all surviving CD46 Tg mice developed ankle arthritis at day 35 after infection, whereas non-Tg mice did not develop ankle arthritis on the infected hind paws. Finally, CD46 Tg mice developed a pus-filled abscess accompanied by renal failure at day 6 or later after infection. These observations suggest that CD46, the host cell-surface pathogen receptor, functioned to attract GGS_124 into deep tissues, so that the subcutaneous infection with GGS_124 induced invasive streptococcal diseases in CD46 Tg mice.
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Affiliation(s)
- Haruno Yoshida
- Kitasato Institute for Life Sciences and Graduate School of Infection Control Sciences, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8641, Japan
| | - Tetsufumi Takahashi
- Center for Clinical Pharmacy and Clinical Sciences, School of Pharmaceutical Sciences, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8641, Japan
| | - Masahiko Nakamura
- Center for Clinical Pharmacy and Clinical Sciences, School of Pharmaceutical Sciences, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8641, Japan
| | - Anders Øverby
- Center for Clinical Pharmacy and Clinical Sciences, School of Pharmaceutical Sciences, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8641, Japan
| | - Takashi Takahashi
- Kitasato Institute for Life Sciences and Graduate School of Infection Control Sciences, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8641, Japan
| | - Kimiko Ubukata
- Kitasato Institute for Life Sciences and Graduate School of Infection Control Sciences, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8641, Japan
| | - Hidenori Matsui
- Kitasato Institute for Life Sciences and Graduate School of Infection Control Sciences, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8641, Japan.
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Trell K, Sendi P, Rasmussen M. Recurrent bacteremia with Streptococcus dysgalactiae: a case-control study. Diagn Microbiol Infect Dis 2016; 85:121-4. [PMID: 26906192 DOI: 10.1016/j.diagmicrobio.2016.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 01/07/2016] [Accepted: 01/17/2016] [Indexed: 10/22/2022]
Abstract
Beta-hemolytic streptococci of groups C and G, designated as Streptococcus dysgalactiae (SD), can cause severe and recurring invasive infections. In this case-control study, we aimed to identify clinical and molecular risk factors for recurrence of SD bacteremia. Twenty-two cases of recurrent SD bacteremia were identified, and median time between episodes was 6 months. The most frequent clinical manifestation was skin and soft tissue infection. Cases and 92 controls, with single-episode SD bacteremia, showed similar demographics, had similar Charlson comorbidity scores, and had similar clinical presentations. Thirty-day fatality was 13% among controls, whereas none of 22 cases died. In 19 cases (86%), the same emm type was encountered in both episodes. SD isolates from recurrent episodes and from single episodes had a similar emm type distribution. Thus, we did not identify clinical risk factors for recurrences. The high proportion of identical emm types in recurrent episodes indicates a host-specific colonization.
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Affiliation(s)
- Kristina Trell
- The Division of Infection Medicine, Department of Clinical Sciences, Lund University, Sweden
| | - Parham Sendi
- Department of Infectious Diseases, University Hospital Bern and University of Bern, Switzerland
| | - Magnus Rasmussen
- The Division of Infection Medicine, Department of Clinical Sciences, Lund University, Sweden.
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Watanabe S, Takemoto N, Ogura K, Miyoshi-Akiyama T. Severe invasive streptococcal infection by Streptococcus pyogenes
and Streptococcus dysgalactiae
subsp. equisimilis. Microbiol Immunol 2016; 60:1-9. [DOI: 10.1111/1348-0421.12334] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 10/15/2015] [Accepted: 10/29/2015] [Indexed: 12/23/2022]
Affiliation(s)
- Shinya Watanabe
- Division of Bacteriology; Department of Infection and Immunity; School of Medicine; Jichi Medical University; 3311-1 Yakushiji Shimotsuke-shi Tochigi 329-0498
| | - Norihiko Takemoto
- Pathogenic Microbe Laboratory; Research Institute; National Center for Global Health and Medicine; 1-21-1 Toyama Shinjuku Tokyo 162-8655, Japan
| | - Kohei Ogura
- Pathogenic Microbe Laboratory; Research Institute; National Center for Global Health and Medicine; 1-21-1 Toyama Shinjuku Tokyo 162-8655, Japan
| | - Tohru Miyoshi-Akiyama
- Pathogenic Microbe Laboratory; Research Institute; National Center for Global Health and Medicine; 1-21-1 Toyama Shinjuku Tokyo 162-8655, Japan
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Bruun T, Oppegaard O, Kittang BR, Mylvaganam H, Langeland N, Skrede S. Etiology of Cellulitis and Clinical Prediction of Streptococcal Disease: A Prospective Study. Open Forum Infect Dis 2015; 3:ofv181. [PMID: 26734653 PMCID: PMC4699398 DOI: 10.1093/ofid/ofv181] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 11/15/2015] [Indexed: 11/14/2022] Open
Abstract
Background. The importance of bacteria other than group A streptococci (GAS) in different clinical presentations of cellulitis is unclear, commonly leading to treatment with broad-spectrum antibiotics. The aim of this study was to describe the etiological and clinical spectrum of cellulitis and identify clinical features predicting streptococcal etiology. Methods. We prospectively enrolled 216 patients hospitalized with cellulitis. Clinical details were registered. Bacterial culture was performed from blood, cutaneous or subcutaneous tissue, and/or swabs from skin lesions. Paired serum samples were analyzed for anti-streptolysin O and anti-deoxyribonuclease B antibodies. Results. Serology or blood or tissue culture confirmed β-hemolytic streptococcal (BHS) etiology in 72% (146 of 203) of cases. An additional 13% (27 of 203) of cases had probable BHS infection, indicated by penicillin response or BHS cultured from skin swabs. β-hemolytic streptococcal etiology was predominant in all clinical subgroups, including patients without sharply demarcated erythema. β-hemolytic group C or G streptococci (GCS/GGS) were more commonly isolated than GAS (36 vs 22 cases). This predominance was found in the lower extremity infections. Group C or G streptococci in swabs were associated with seropositivity just as often as GAS. Staphylococcus aureus was cultured from swabs as a single pathogen in 24 cases, 14 (64%) of which had confirmed BHS etiology. Individual BHS-associated clinical characteristics increased the likelihood of confirmed BHS disease only slightly; positive likelihood ratios did not exceed 2.1. Conclusions. β-hemolytic streptococci were the dominating cause of cellulitis in all clinical subgroups and among cases with S aureus in cutaneous swabs. Group C or G streptococci were more frequently detected than GAS. No single clinical feature substantially increased the probability of confirmed BHS etiology.
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Affiliation(s)
- Trond Bruun
- Department of Clinical Science, University of Bergen; Departments of Medicine
| | - Oddvar Oppegaard
- Department of Clinical Science, University of Bergen; Departments of Medicine
| | - Bård R Kittang
- Department of Clinical Science, University of Bergen; Department of Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | | | - Nina Langeland
- Department of Clinical Science, University of Bergen; Departments of Medicine
| | - Steinar Skrede
- Department of Clinical Science, University of Bergen; Departments of Medicine
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Leitner E, Zollner-Schwetz I, Zarfel G, Masoud-Landgraf L, Gehrer M, Wagner-Eibel U, Grisold AJ, Feierl G. Prevalence of emm types and antimicrobial susceptibility of Streptococcus dysgalactiae subsp. equisimilis in Austria. Int J Med Microbiol 2015; 305:918-24. [PMID: 26507866 DOI: 10.1016/j.ijmm.2015.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 09/18/2015] [Accepted: 10/11/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES An increase of severe infections caused by Streptococcus dysgalactiae subsp. equisimilis (SDSE) similar to infections caused by Streptococcus pyogenes has been reported over the last years. Little is known about infections with SDSE in Austria. Therefore, we investigated a collection of 113 SDSE invasive and non-invasive isolates from different infection sites and type of infections as well as patients' characteristics. METHODS The isolates were phenotypically identified and emm typed using the enlarged emm database from the Centers for Disease Control and Prevention. Additionally, 13 antimicrobial agents were tested using EUCAST guidelines and virulence genes were investigated. RESULTS Severe SDSE infections were most common in elderly men with underlying diseases especially diabetes mellitus. With VitekMS identification of SDSE isolates was successful to the species level only. Emm typing revealed 24 different emm types, one new type and one new subtype. StG485, stG6, stC74a, stG643, and stG480 were the predominant types in this study, stC74a and stG652 in invasive infections and stG643, stC74a and stG485 in non-invasive infections. Resistance was observed to tetracycline (62%), macrolides (13%) with one M phenotype, and clindamycin (12%) presenting 6 constitutive MLS(B) phenotypes and 8 inducible MLS(B) phenotypes. Levofloxacin resistance was detected only in one isolate. All isolates tested for virulence genes were positive for scpA, ska, saga and slo. Superantigenic genes were negative except speG(dys) (positive 17/34; 50%). CONCLUSION This paper presents the first report of SDSE infections in Austria. Severe SDSE infections were found mainly in elderly men with underlying diseases. SDSE isolates demonstrated substantial emm type diversity without association with infections site or invasiveness. Analysis of virulence genes showed no significant difference between invasive and non-invasive infections.
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Affiliation(s)
- Eva Leitner
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Austria
| | - Ines Zollner-Schwetz
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Austria.
| | - Gernot Zarfel
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Austria
| | - Lilian Masoud-Landgraf
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Austria
| | - Michael Gehrer
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Austria
| | - Ute Wagner-Eibel
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Austria
| | - Andrea J Grisold
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Austria
| | - Gebhard Feierl
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Austria
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Silva LG, Genteluci GL, Corrêa de Mattos M, Glatthardt T, Sá Figueiredo AM, Ferreira-Carvalho BT. Group C Streptococcus dysgalactiae subsp. equisimilis in south-east Brazil: genetic diversity, resistance profile and the first report of human and equine isolates belonging to the same multilocus sequence typing lineage. J Med Microbiol 2015; 64:551-558. [DOI: 10.1099/jmm.0.000052] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 03/08/2015] [Indexed: 11/18/2022] Open
Affiliation(s)
- Ligia Guedes Silva
- Universidade Federal do Rio de Janeiro, Instituto de Microbiologia Paulo de Góes, RJ, Brazil
| | | | - Marcos Corrêa de Mattos
- Universidade Federal do Rio de Janeiro, Instituto de Microbiologia Paulo de Góes, RJ, Brazil
| | - Thaís Glatthardt
- Universidade Federal do Rio de Janeiro, Instituto de Microbiologia Paulo de Góes, RJ, Brazil
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Bergmann R, Nitsche-Schmitz DP. Small plasmids in Streptococcus dysgalactiae subsp. equisimilis isolated from human infections in southern India and sequence analysis of two novel plasmids. Int J Med Microbiol 2015; 305:365-9. [PMID: 25769407 DOI: 10.1016/j.ijmm.2015.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 01/06/2015] [Accepted: 02/09/2015] [Indexed: 11/26/2022] Open
Abstract
Small plasmids are frequently found in S. pyogenes isolates from human infections in India. Streptococcus dysgalactiae subsp. equisimilis (SDSE) is a streptococcal subspecies that is genetically similar to S. pyogenes and has a similar ecology. Therefore, we determined the distribution of small plasmids in a collection of 254 SDSE isolates, comprising 44 different emm-types and emm non-typable strains, from southern India, utilizing an established PCR based method. Briefly, 1.2% (n=3) of the isolates were positive for repA (encoding the replication initiation protein A) and 1.6% (n=4) were repB positive (encoding the replication initiation protein B). One isolate (G315) showed a co-detection of repB and dysA (encoding the bacteriocin dysgalacticin) which is characteristic for previously described pDN281/pW2580-like plasmids, observed in SDSE and S. pyogenes. The remaining plasmid bearing isolates showed no characteristic co-detection of known plasmid-associated genes. Thus, plasmids pG271 and pG279, representatives for repB and repA harboring plasmids, respectively, were analyzed. The plasmids pG271 and pG279 could be assigned to the pMV158 and the pC194/pUB110 family of rolling-circle plasmids, respectively. Like the characterized small native plasmids of S. pyogenes from India, the SDSE plasmids discovered and described in this study did not carry any of the known antibiotic resistance genes. SDSE bore less of the investigated small native plasmids that were distinct from the small native plasmids of S. pyogenes of the same geographic region. This indicates a low rate of lateral transfer of these genetic elements between these two related streptococcal species.
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Affiliation(s)
- René Bergmann
- Department of Medical Microbiology, Helmholtz Centre for Infection Research, Inhoffenstrasse 7, D-38124 Braunschweig, Germany.
| | - D Patric Nitsche-Schmitz
- Department of Medical Microbiology, Helmholtz Centre for Infection Research, Inhoffenstrasse 7, D-38124 Braunschweig, Germany
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Beta-haemolytic group A, C and G streptococcal infections in Western Norway: a 15-year retrospective survey. Clin Microbiol Infect 2014; 21:171-8. [PMID: 25658557 DOI: 10.1016/j.cmi.2014.08.019] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 08/13/2014] [Accepted: 08/16/2014] [Indexed: 11/24/2022]
Abstract
Pyogenic streptococci cause significant morbidity and mortality, and the incidence of invasive group C and G streptococcal disease appears to be increasing. In this retrospective study we describe the epidemiological characteristics of invasive group A, C and G, along with non-invasive group C and G streptococcal infections in Western Norway from 1999 to 2013. A total of 512 invasive streptococcal infections were identified, of these 297 (58%) were group A (GAS), 24 (5%) group C (GCS) and 188 (37%) group G streptococci (GGS). In the non-invasive group, 4935 GCS and GGS-infections were identified. GCS and GGS were treated as one group (GCGS) for statistical purposes. All microbial categories displayed increasing incidence with age, seasonal variation and a male predominance. The incidence of invasive GCGS infections increased significantly from 1.4/100,000 inhabitants in 1999 to 6.3/100,000 in 2013 (p <0.001). Conversely, the annual rates of invasive GAS infection exhibited marked fluctuations, ranging from 2.7/100,000 (2000) to 8.3/100,000 (1999), but no significant temporal trends were observed. The incidence of non-invasive GCGS infections decreased significantly during the study period (p <0.001). The most frequently encountered emm-types among the 209 iGAS-isolates analysed were emm1 (24%), emm3 (14%) and emm28 (14%); whereas stG643 (19%), stG485 (15%) and stG6 (13%) were most prevalent among the 122 iGCGS-isolates available for typing. The increasing burden of invasive β-haemolytic streptococcal disease in our community calls for sustained attentiveness to the clinical and molecular aspects of GAS, GCS and GGS infections.
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Abstract
PURPOSE OF REVIEW Increasing disease caused by beta-haemolytic streptococci indicates the need for improved understanding of pathogenesis. RECENT FINDINGS Streptococcus pyogenes, or group A Streptococcus (GAS), causes significant disease worldwide. The closely related Streptococcus dysgalactiae subspecies equisimilis (SDSE) is increasingly recognized as causing a similar disease spectrum. Whole-genome sequencing applied to the study of outbreaks may reveal factors that contribute to pathogenesis and changes in epidemiology. The role of quorum sensing in biofilm formation, and interspecies communication with other streptococci, is discussed. GAS has evolved multiple mechanisms to evade the humoral arm of innate immunity, including complement, which is well known in protecting the host from bacteria, and the coagulation-fibrinolytic system, which is increasingly recognized as an innate immune effector. SUMMARY Molecular biology has enhanced our understanding of the intricate balance of host-pathogen interactions that result in clearance or establishment of invasive streptococcal infection. Although the skin and oropharynx remain the usual ecological niche of GAS and SDSE, occasionally the bacteria find themselves within deeper tissues and blood. Recent research has armed us with better knowledge of bacterial adaptations to this alternative environment. However, the challenge is to translate this knowledge into clinical practice, through the development of novel therapeutic options and ultimately a vaccine against GAS.
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Streptococcus dysgalactiae subsp. equisimilis bacteremia: an emerging infection. Eur J Clin Microbiol Infect Dis 2014; 33:1303-10. [PMID: 24682845 DOI: 10.1007/s10096-014-2092-0] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 03/10/2014] [Indexed: 10/25/2022]
Abstract
The importance of group C and G Streptococcus dysgalactiae subspecies equisimilis (S. dysgalactiae subsp. equisimilis) as a significant pathogen has recently been better recognized. S. dysgalactiae subsp. equisimilis disease can range in severity from milder skin and soft-tissue conditions such as wound infection, erysipelas, and cellulitis, to life-threatening necrotizing fasciitis and streptococcal toxic shock syndrome, thus sharing the clinical picture with S. pyogenes. The most common clinical manifestation of bacteremia is cellulitis. An increase in the incidence of S. dysgalactiae subsp. equisimilis bacteremia has been recognized. Invasive forms of this infection are most commonly found in elderly patients with underlying comorbidities and skin breakdown. The case fatality in bacteremia has been reported to be 15-18%. In this review, the epidemiology, clinical characteristics, and emm types of S. dysgalactiae subsp. equisimilis bacteremia are summarized.
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