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Not so uncommon, yet neglected 'Severe Streptococcus pyogenes infections at a tertiary care center in south India. Indian J Med Microbiol 2023; 41:55-58. [PMID: 36870752 DOI: 10.1016/j.ijmmb.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 12/13/2022] [Accepted: 12/20/2022] [Indexed: 01/13/2023]
Abstract
Streptococcus pyogenes (SP) causes uncomplicated infections of throat & skin to severe life-threatening invasive diseases and poststreptococcal sequelae. Despite being common, it hasn't been studied much in recent times. Data of 93 adult patients >18 years, culture proven (SP) infections from 2016 to 2019 was studied in south India. Irrespective of comorbidities, SSTI were most common followed by surgical site infections& bacteremia. Isolates were susceptible to penicillin, cephalosporins but 23% were resistant to clindamycin. Timely surgical interventions and appropriate antibiotics reduced morbidity& limb salvage by 9 times. Larger studies, worldwide, to see the current trend of SP need to be conducted.
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Infectious Aneurysms Caused by Streptococcus Pyogenes in Children. Pediatr Infect Dis J 2022; 41:e442-e444. [PMID: 35895891 DOI: 10.1097/inf.0000000000003651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We describe the detailed clinical course of rapidly enlarging infective aneurysms during the treatment of endocarditis and purulent pericarditis caused by Streptococcus pyogenes . We show that S. pyogenes aneurysms can enlarge rapidly within 1-2 days. Moreover, we highlight the benefit of transporting patients to a facility offering multidisciplinary treatment, even if vital signs stabilize to the point.
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3
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Ruch Y, Hansmann Y, Riegel P, Lefebvre N, Mazzucotelli JP, Douiri N, Martin A, Argemi X. Virulence of beta-hemolytic streptococci in infective endocarditis. Infection 2019; 48:91-97. [PMID: 31520396 DOI: 10.1007/s15010-019-01358-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 09/06/2019] [Indexed: 01/25/2023]
Abstract
BACKGROUND Streptococci involved in infective endocarditis (IE) primarily comprise alpha- or non-hemolytic streptococci (ANHS). Moreover, beta-hemolytic streptococci (BHS) can be involved, and guidelines recommend the addition of gentamicin for the first 2 weeks of treatment and the consideration of early surgery in such cases. This study compared the morbidity and mortality associated with IE depending on the microorganisms involved (BHS, ANHS, staphylococci, and enterococci). METHODS We conducted a retrospective observational study between 2012 and 2017 in a single hospital in France. The endpoints were overall in-hospital mortality, 1-year mortality and the occurrence of complications. RESULTS We analyzed 316 episodes of definite IE including 150 (38%), 96 (25%), 46 (12%), and 24 cases (6%) of staphylococcal, ANHS, enterococcal, and BHS IE, respectively. In-hospital mortality was significantly higher in the staphylococcal (n = 40; 26.7%) and BHS groups (n = 6; 25.0%) than in the ANHS (n = 9; 9.4%) and enterococcal groups (n = 5; 10.9%) (all p < 0.01). The rates of septic shock and cerebral emboli were also higher in the BHS group than in the ANHS group [n = 7 (29.2%) vs. n = 3 (3.1%), p < 0.001; n = 7 (29.2%) vs. n = 12 (12.5%); p = 0.05, respectively]. CONCLUSION This study confirmed that BHS IE has a more severe prognosis than ANHS IE. The virulence of BHS may be similar to that of staphylococci, justifying increased monitoring of these patients and more 'aggressive' treatments such as early surgery.
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Affiliation(s)
- Yvon Ruch
- Department of Infectious Disease, Strasbourg University Hospital, Strasbourg, France. .,Service de Maladies Infectieuses et Tropicales, Centre Hospitalo, Universitaire de Strasbourg, 1 place de l'hôpital, BP 426, 67091, Strasbourg Cedex, France.
| | - Yves Hansmann
- Department of Infectious Disease, Strasbourg University Hospital, Strasbourg, France
| | - Philippe Riegel
- Laboratory of Bacteriology, Strasbourg University Hospital, Strasbourg, France
| | - Nicolas Lefebvre
- Department of Infectious Disease, Strasbourg University Hospital, Strasbourg, France
| | | | - Nawal Douiri
- Department of Infectious Disease, Strasbourg University Hospital, Strasbourg, France
| | - Aurélie Martin
- Department of Infectious Disease, Strasbourg University Hospital, Strasbourg, France
| | - Xavier Argemi
- Department of Infectious Disease, Strasbourg University Hospital, Strasbourg, France
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Sarda C, Magrini G, Pelenghi S, Turco A, Seminari E. Mitral Valve Infective Endocarditis due to Streptococcus pyogenes: A Case Report. Cureus 2019; 11:e4461. [PMID: 31249739 PMCID: PMC6579330 DOI: 10.7759/cureus.4461] [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] [Indexed: 11/17/2022] Open
Abstract
Infective endocarditis (IE) due to group A β-hemolytic streptococcus (Streptococcus pyogenes) has rarely been reported in the literature. We herein report a Streptococcus pyogenes native mitral valve endocarditis in a young patient and a review of the literature. The patient had a native mitral valve endocarditis with vegetation; his hemodynamic stability and a short course of antibiotic treatment prevented urgent surgery on the mitral valve. He was previously treated with cefixime and azithromycin for four days and then, upon hospital admission, with vancomycin plus amoxicillin-clavulanate. After the diagnosis of IE due to Streptococcus pyogenes, treatment with gentamicin (3 mg/kg daily) and ampicillin (12 g/day) was implemented. The patient underwent weekly echocardiographic evaluations during antibiotic treatment to document the resolution of the vegetations. He was discharged to home in good clinical conditions after a four-week course of antibiotic treatment.
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Affiliation(s)
- Cristina Sarda
- Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, ITA
| | - Giulia Magrini
- Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia , ITA
| | - Sfefano Pelenghi
- Cardiac Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, ITA
| | - Annalisa Turco
- Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, ITA
| | - Elena Seminari
- Infectious Diseses, Fondazione IRCCS Policlinico San Matteo, Pavia, ITA
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Severe emm89 Group A Streptococcal Disease Characterized by Toxic Shock and Endocarditis. Case Rep Infect Dis 2019; 2019:6568732. [PMID: 30805230 PMCID: PMC6360552 DOI: 10.1155/2019/6568732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/01/2019] [Indexed: 11/17/2022] Open
Abstract
Invasive group A Streptococcus infections are associated with diverse presentations. We report a severe, rare case of GAS infection with dissemination including endocarditis and STSS. While whole genome sequencing of blood and pharyngeal isolates did not reveal any unique features attributable to the severe presentation, our approach serves as a template for investigation of severe manifestations of common infections.
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6
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Savoia P, Heininger U, Buettcher M. Streptococcus pyogenes Endocarditis Associated With Varicella-Case Report and Review of the Literature. Front Pediatr 2019; 7:500. [PMID: 31867295 PMCID: PMC6904297 DOI: 10.3389/fped.2019.00500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 11/19/2019] [Indexed: 01/29/2023] Open
Abstract
Infection with varicella zoster virus (VZV) is usually a benign and self-limiting disease. Serious complications by bacterial pathogens do occur, such as necrotising fasciitis (NF). One of the most important is Streptococcus pyogenes (or Group A Streptococcus, GAS), which colonizes epithelial surfaces, primarily of the throat and skin. In rare instances, varicella may also be associated with S. pyogenes endocarditis. Review of the literature reveals only 18 children with infective endocarditis (IE) caused by GAS since 1942. VZV as antecedent illness was found in five (28%). Fourteen (78%) had no pre-existing cardiac abnormalities. Death occurred in three (17%) children. Infective endocarditis with acute deterioration secondary to rupture of mitral valve chordae tendineae necessitating cardiac surgery has not been reported in the literature yet. We present this rare and instructive pediatric case and the results of a literature search on S. pyogenes endocarditis in children.
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Affiliation(s)
- Patrizia Savoia
- Paediatric Intensive Care and Neonatology, Lucerne Children's Hospital, Cantonal Hospital Lucerne, Lucerne, Switzerland
| | - Ulrich Heininger
- Department of Paediatric Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | - Michael Buettcher
- Paediatric Infectious Diseases, Lucerne Children's Hospital, Cantonal Hospital Lucerne, Lucerne, Switzerland
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Taverniti V, Dalla Via A, Minuzzo M, Del Bo' C, Riso P, Frøkiær H, Guglielmetti S. In vitro assessment of the ability of probiotics, blueberry and food carbohydrates to prevent S. pyogenes adhesion on pharyngeal epithelium and modulate immune responses. Food Funct 2018; 8:3601-3609. [PMID: 28891576 DOI: 10.1039/c7fo00829e] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Group A streptococci (GAS) cause 20-30% of pediatric pharyngitis episodes, which are a major cause of ambulatory care visits. Therefore, a strategy to prevent GAS dissemination in children could significantly benefit public healthcare. Contextually, we assessed the possibility of employing alternative food-grade strategies to be used with the oral probiotic L. helveticus MIMLh5 for the prevention of pharyngeal infections. First, we demonstrated through an antagonism-by-exclusion assay that guaran may potentially prevent S. pyogenes adhesion on pharyngeal cells. Subsequently, we showed that an anthocyanin-rich fraction extracted from wild blueberry (BbE) exerts anti-inflammatory effects on the human macrophage cell line U937. Finally, we showed that BbE reduces interferon-β expression in MIMLh5-stimulated murine dendritic cells, resulting in a reduction in the pro-inflammatory cytokines IL-12 and TNF-α. In conclusion, this proof-of-concept study indicates that different food-grade strategies may be concomitantly adopted to potentially prevent GAS colonization and modulate local immune defences.
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Affiliation(s)
- Valentina Taverniti
- Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Italy.
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8
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Suzuki T, Mawatari M, Iizuka T, Amano T, Kutsuna S, Fujiya Y, Takeshita N, Hayakawa K, Ohmagari N. An Ineffective Differential Diagnosis of Infective Endocarditis and Rheumatic Heart Disease after Streptococcal Skin and Soft Tissue Infection. Intern Med 2017; 56:2361-2365. [PMID: 28794364 PMCID: PMC5635315 DOI: 10.2169/internalmedicine.8411-16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 01/24/2017] [Indexed: 11/06/2022] Open
Abstract
We herein report the case of a 68-year-old woman with a skin and soft tissue infection at her extremities. The blood culture results were positive for Streptococcus pyogenes, and we started treatment using ampicillin and clindamycin, although subsequent auscultation revealed a new-onset heart murmur. We therefore suspected rheumatic heart disease and infective endocarditis. The case met both the Jones criteria and the modified Duke criteria. Transesophageal echocardiography revealed vegetation on the aortic valve, although the pathological findings were also compatible with both rheumatic heart disease and infective endocarditis. The present findings suggest that these two diseases can coexist in some cases.
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Affiliation(s)
- Tetsuya Suzuki
- Department of Internal Medicine, Nerima Hikarigaoka Hospital, Japan
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Momoko Mawatari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
- Infection Control and Prevention Center, Gunma University Hospital, Japan
| | - Toshihiko Iizuka
- Department of Diagnostic Pathology, National Center for Global Health and Medicine, Japan
| | | | - Satoshi Kutsuna
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Yoshihiro Fujiya
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Nozomi Takeshita
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Kayoko Hayakawa
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
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9
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Inoue K, Hagiwara A, Kimura A, Ohmagari N. A complication of meningitis and infective endocarditis due to Streptococcus pyogenes. BMJ Case Rep 2017; 2017:bcr-2017-220847. [PMID: 28747418 DOI: 10.1136/bcr-2017-220847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We described a rare case of meningitis and infective endocarditis (IE) due to Streptococcus pyogenes. An 80-year-old woman was admitted to our hospital with unconsciousness. Glasgow Coma Scale was E1V3M5. We diagnosed her with acute meningitis due to S. pyogenes and started treatment using ceftriaxone. In spite of the improvement of her unconscious state, she developed a new-onset systolic murmur on day 13, and echocardiography revealed severe mitral valve regurgitation with vegetation. Therefore, we also diagnosed her with IE and continued the antibiotics for 6 weeks after we confirmed the negative blood cultures. The patient was finally transferred to another hospital for rehabilitation 57 days after admission. Considering that the number of S. pyogenes infections has been reported to increase in Japan and worldwide, we need to be more careful about the rare complication of meningitis and IE due to S. pyogenes.
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Affiliation(s)
- Kosuke Inoue
- Endocrinology and Diabetes Center, Yokohama Rosai Hospital, Yokohama, Japan
| | - Akiyoshi Hagiwara
- Department of Emergency Medicine and Critical Care, National Center for Global Health and Medicine, Tokyo, Japan
| | - Akio Kimura
- Department of Emergency Medicine and Critical Care, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
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10
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Wang SC, Torosoff MT, Smith RP, Coates AD. Streptococcus pyogenes meningitis and endocarditis in a patient with prosthetic mitral valve. J Cardiol Cases 2017; 16:82-84. [PMID: 30279803 DOI: 10.1016/j.jccase.2017.05.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/10/2017] [Accepted: 05/22/2017] [Indexed: 11/18/2022] Open
Abstract
Streptococcus pyogenes is commonly found in cutaneous and pharyngeal infections, but rarely causes meningitis and endocarditis. We report a 77-year-old male with history of prosthetic mitral valve, presenting with meningitis and endocarditis secondary to S. pyogenes. We aim to raise awareness among clinicians of rare infectious etiology as the cause of endocarditis and meningitis, and importance of prompt diagnosis in ensuring success of medical treatment and long-term survival. <Learning objective: Main learning objectives are: (1) Rare sources of infection should be considered in setting of endocarditis and meningitis. (2) In high-risk patients, transesophageal echocardiogram is indicated although initial transthoracic echocardiogram may not show classic vegetation.>.
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Affiliation(s)
- Stephani C Wang
- Department of Medicine, Albany Medical Center, Albany, NY, USA
| | - Mikhail T Torosoff
- Cardiology, Department of Medicine, Albany Medical College, Albany, NY, USA
| | - Raymond P Smith
- Department of Medicine, Albany Medical Center, Albany, NY, USA
| | - Andrew D Coates
- Department of Medicine, Albany Medical Center, Albany, NY, USA
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11
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Beye M, El Karkouri K, Labas N, Raoult D, Fournier PE. Genomic analysis of a Streptococcus pyogenes strain causing endocarditis in a child. New Microbes New Infect 2017; 17:1-6. [PMID: 28239478 PMCID: PMC5318540 DOI: 10.1016/j.nmni.2017.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Revised: 01/03/2017] [Accepted: 01/11/2017] [Indexed: 11/16/2022] Open
Abstract
We sequenced the genome of Streptococcus pyogenes strain G773 that caused an infective endocarditis in a 4-year-old boy suffering from acute endocarditis. The 1.9-Mb genome exhibited a specific combination of virulence factors including a complete integrative and conjugative element, sp2905, previously described as incomplete in S. pyogenes, and five bacteriocin-coding genes. However, strain G773 lacked a CRISPR-Cas system.
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Affiliation(s)
- M Beye
- URMITE, UM63, CNRS7278, IRD198, Inserm1095, Institut Hospitalo-Universitaire Méditerranée-infection, Aix-Marseille Université, Faculté de Médecine, Marseille, France
| | - K El Karkouri
- URMITE, UM63, CNRS7278, IRD198, Inserm1095, Institut Hospitalo-Universitaire Méditerranée-infection, Aix-Marseille Université, Faculté de Médecine, Marseille, France
| | - N Labas
- URMITE, UM63, CNRS7278, IRD198, Inserm1095, Institut Hospitalo-Universitaire Méditerranée-infection, Aix-Marseille Université, Faculté de Médecine, Marseille, France
| | - D Raoult
- URMITE, UM63, CNRS7278, IRD198, Inserm1095, Institut Hospitalo-Universitaire Méditerranée-infection, Aix-Marseille Université, Faculté de Médecine, Marseille, France; Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdul Aziz University, Jeddah, Saudi Arabia
| | - P-E Fournier
- URMITE, UM63, CNRS7278, IRD198, Inserm1095, Institut Hospitalo-Universitaire Méditerranée-infection, Aix-Marseille Université, Faculté de Médecine, Marseille, France
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