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Sherwood E, Vergnano S, Kakuchi I, Bruce MG, Chaurasia S, David S, Dramowski A, Georges S, Guy R, Lamagni T, Levy-Bruhl D, Lyytikäinen O, Naus M, Okaro JO, Oppegaard O, Vestrheim DF, Zulz T, Steer AC, Van Beneden CA, Seale AC. Invasive group A streptococcal disease in pregnant women and young children: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2022; 22:1076-1088. [PMID: 35390294 PMCID: PMC9217756 DOI: 10.1016/s1473-3099(21)00672-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/28/2021] [Accepted: 10/12/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The incidence of invasive disease caused by group A streptococcus (GAS) has increased in multiple countries in the past 15 years. However, despite these reports, to the best of our knowledge, no systematic reviews and combined estimates of the incidence of invasive GAS have been done in key high-risk groups. To address this, we estimated the incidence of invasive GAS disease, including death and disability outcomes, among two high-risk groups-namely, pregnant women and children younger than 5 years. METHODS We did a systematic review and meta-analyses on invasive GAS outcomes, including incidence, case fatality risks, and neurodevelopmental impairment risk, among pregnant women, neonates (younger than 28 days), infants (younger than 1 year), and children (younger than 5 years) worldwide and by income region. We searched several databases for articles published from Jan 1, 2000, to June 3, 2020, for publications that reported invasive GAS outcomes, and we sought unpublished data from an investigator group of collaborators. We included studies with data on invasive GAS cases, defined as laboratory isolation of Streptococcus pyogenes from any normally sterile site, or isolation of S pyogenes from a non-sterile site in a patient with necrotising fasciitis or streptococcal toxic shock syndrome. For inclusion in pooled incidence estimates, studies had to report a population denominator, and for inclusion in pooled estimates of case fatality risk, studies had to report aggregate data on the outcome of interest and the total number of cases included as a denominator. We excluded studies focusing on groups at very high risk (eg, only preterm infants). We assessed heterogeneity with I2. FINDINGS Of the 950 published articles and 29 unpublished datasets identified, 20 studies (seven unpublished; 3829 cases of invasive GAS) from 12 countries provided sufficient data to be included in pooled estimates of outcomes. We did not identify studies reporting invasive GAS incidence among pregnant women in low-income and middle-income countries (LMICs) nor any reporting neurodevelopmental impairment after invasive GAS in LMICs. In nine studies from high-income countries (HICs) that reported invasive GAS in pregnancy and the post-partum period, invasive GAS incidence was 0·12 per 1000 livebirths (95% CI 0·11 to 0·14; I2=100%). Invasive GAS incidence was 0·04 per 1000 livebirths (0·03 to 0·05; I2=100%; 11 studies) for neonates, 0·13 per 1000 livebirths (0·10 to 0·16; I2=100%; ten studies) for infants, and 0·09 per 1000 person-years (95% CI 0·07 to 0·10; I2=100%; nine studies) for children worldwide; 0·12 per 1000 livebirths (95% CI 0·00 to 0·24; I2=100%; three studies) in neonates, 0·33 per 1000 livebirths (-0·22 to 0·88; I2=100%; two studies) in infants, and 0·22 per 1000 person-years (0·13 to 0·31; I2=100%; two studies) in children in LMICs; and 0·02 per 1000 livebirths (0·00 to 0·03; I2=100%; eight studies) in neonates, 0·08 per 1000 livebirths (0·05 to 0·11; I2=100%; eight studies) in infants, and 0·05 per 1000 person-years (0·03 to 0·06; I2=100%; seven studies) in children for HICs. Case fatality risks were high, particularly among neonates in LMICs (61% [95% CI 33 to 89]; I2=54%; two studies). INTERPRETATION We found a substantial burden of invasive GAS among young children. In LMICs, little data were available for neonates and children and no data were available for pregnant women. Incidences of invasive GAS are likely to be underestimates, particularly in LMICs, due to low GAS surveillance. It is essential to improve available data to inform development of prevention and management strategies for invasive GAS. FUNDING Wellcome Trust.
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Affiliation(s)
- Emma Sherwood
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - Stefania Vergnano
- Paediatric Infectious Diseases, Bristol Royal Hospital for Children, University Hospitals Bristol NHS, Bristol, UK
| | - Isona Kakuchi
- Paediatric Infectious Diseases, Bristol Royal Hospital for Children, University Hospitals Bristol NHS, Bristol, UK
| | - Michael G Bruce
- Centers for Disease Control and Prevention, Arctic Investigations Program, Anchorage, Alaska, USA
| | - Suman Chaurasia
- Department of Paediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Samara David
- British Columbia Centre for Disease Control, University of British Columbia, BC, Canada
| | - Angela Dramowski
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Scarlett Georges
- Infectious Diseases Department, Santé Publique France, French National Public Health Agency, St Maurice, France
| | - Rebecca Guy
- National Infection Service, UK Health Security Agency, London, UK
| | - Theresa Lamagni
- National Infection Service, UK Health Security Agency, London, UK
| | - Daniel Levy-Bruhl
- Infectious Diseases Department, Santé Publique France, French National Public Health Agency, St Maurice, France
| | - Outi Lyytikäinen
- National Institute for Health and Welfare, Department of Health Security, Infectious Disease Control and Vaccinations Unit, Helsinki, Finland
| | - Monika Naus
- British Columbia Centre for Disease Control, University of British Columbia, BC, Canada
| | | | - Oddvar Oppegaard
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Didrik F Vestrheim
- Department of Vaccine Preventable Diseases, Norwegian Institute of Public Health, Oslo, Norway
| | - Tammy Zulz
- Centers for Disease Control and Prevention, Arctic Investigations Program, Anchorage, Alaska, USA
| | - Andrew C Steer
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | | | - Anna C Seale
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Characteristics of Streptococcus pyogenes Versus Streptococcus pneumoniae Pleural Empyema and Pneumonia With Pleural Effusion in Children. Pediatr Infect Dis J 2020; 39:799-802. [PMID: 32804461 DOI: 10.1097/inf.0000000000002699] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Streptococcus pneumoniae is the most common cause of complicated pneumonia in children, but its incidence is decreasing since the introduction of the antipneumococcal conjugated vaccines. Streptococcus pyogenes is an uncommon cause of community-acquired pleuropneumonia/empyema in children, but its relative incidence is rising. METHODS The medical records of all children 0-18 years of age from 2004 to 2019, with discharge diagnoses of pleuropneumonia or empyema, and a positive blood and/or pleural effusion culture for group A streptococcus (GAS) (S. pyogenes), or S. pneumonia (SP) were reviewed. A comparison of clinical and laboratory characteristics for the 2 etiologies was performed. RESULTS Ninety cases of community-acquired pleuropneumonia/empyema caused by these organisms were included: 20 GAS and 70 SP. Compared with children with SP, those with GAS were more likely to have larger pleural effusion requiring drainage and longer hospitalization, and less likely to have a positive blood culture. The relative portion of GAS empyema increased over the study period. CONCLUSIONS Compared with patients with SP empyema, GAS appears to cause more morbidity and a longer hospital stay. This organism is more frequently recovered from pleural fluid without bacteremia, and thus necessitates pleural fluid tap for accurate diagnosis.
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Bruun T, Rath E, Oppegaard O, Skrede S. Beta-Hemolytic Streptococci and Necrotizing Soft Tissue Infections. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1294:73-86. [PMID: 33079364 DOI: 10.1007/978-3-030-57616-5_6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
β-hemolytic streptococci are major causes of necrotizing soft tissue infections (NSTIs), Streptococcus pyogenes (group A streptococcus; GAS) in particular. NSTIs caused by Streptococcus dysgalactiae (SD) have also been reported. In the INFECT cohort of 409 NSTIs patients, more than a third of the cases were caused by GAS (31%) or SD (7%). Risk factors of streptococcal NSTIs compared to streptococcal cellulitis have previously been largely unknown. The INFECT study confirmed blunt trauma as an important risk factor. In addition, absence of pre-existing skin lesions and a lower BMI were associated with NSTIs. The study also confirmed that septic shock is more frequent in GAS cases than in other types of NSTIs. Septic shock was also among several predictors of mortality. The role of intravenous immunoglobulin (IVIG) in streptococcal NSTIs has been unclear. In the INFECT cohort, IVIG treatment was associated with increased survival. As in other studies, a significant microbial diversity was observed, but with predominance of a few emm types. Overall, the INFECT study gives a comprehensive and contemporary picture of the clinical characteristics and the microbes involved in streptococcal NSTIs. The reported severity of disease underscores the need for new efforts aimed at identifying novel diagnostic measures and improved treatment.
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Affiliation(s)
- Trond Bruun
- Department of Clinical Science, University of Bergen, Bergen, Norway.
- Department of Medicine, Haukeland University Hospital, Bergen, Norway.
| | - Eivind Rath
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Oddvar Oppegaard
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Steinar Skrede
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
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Sakai T, Taniyama D, Takahashi S, Nakamura M, Takahashi T. Pleural empyema and streptococcal toxic shock syndrome due to Streptococcus pyogenes in a healthy Spanish traveler in Japan. IDCases 2017; 9:85-88. [PMID: 28725562 PMCID: PMC5506862 DOI: 10.1016/j.idcr.2017.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 06/13/2017] [Indexed: 11/03/2022] Open
Abstract
Group A Streptococcus (GAS, Streptococcus pyogenes) causes invasive infections including streptococcal toxic shock syndrome (STSS) and local infections. To our knowledge, this is the first report of a case of an invasive GAS infection with pneumonia and pleural empyema (PE) followed by STSS (disseminated intravascular coagulation [DIC] and acute renal insufficiency) in a healthy male adult. He received combined supportive therapies of PE drainage, anti-DIC agent, hemodialysis, and antimicrobials and eventually made a clinical recovery. GAS isolated from PE was found to have emm1/speA genes, suggestive of a pathogenic strain. Clinicians should be aware of the possibility of this disease entity (pneumonia, PE, and STSS) in healthy male adults as well as children and adult women.
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Affiliation(s)
- Tetsuya Sakai
- Department of Respiratory Medicine, Tokyo Saiseikai Central Hospital, 1-4-17 Mita, Minato-ku, Tokyo 108-0073, Japan
| | - Daisuke Taniyama
- Department of General Internal Medicine, Tokyo Saiseikai Central Hospital, 1-4-17 Mita, Minato-ku, Tokyo 108-0073, Japan
| | - Saeko Takahashi
- Department of Respiratory Medicine, Tokyo Saiseikai Central Hospital, 1-4-17 Mita, Minato-ku, Tokyo 108-0073, Japan
| | - Morio Nakamura
- Department of Respiratory Medicine, Tokyo Saiseikai Central Hospital, 1-4-17 Mita, Minato-ku, Tokyo 108-0073, Japan
| | - Takashi Takahashi
- Laboratory of Infectious Diseases, Kitasato Institute for Life Sciences & Graduate School of Infection Control Sciences, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8641, Japan
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Bachert BA, Choi SJ, LaSala PR, Harper TI, McNitt DH, Boehm DT, Caswell CC, Ciborowski P, Keene DR, Flores AR, Musser JM, Squeglia F, Marasco D, Berisio R, Lukomski S. Unique Footprint in the scl1.3 Locus Affects Adhesion and Biofilm Formation of the Invasive M3-Type Group A Streptococcus. Front Cell Infect Microbiol 2016; 6:90. [PMID: 27630827 PMCID: PMC5005324 DOI: 10.3389/fcimb.2016.00090] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 08/15/2016] [Indexed: 12/04/2022] Open
Abstract
The streptococcal collagen-like proteins 1 and 2 (Scl1 and Scl2) are major surface adhesins that are ubiquitous among group A Streptococcus (GAS). Invasive M3-type strains, however, have evolved two unique conserved features in the scl1 locus: (i) an IS1548 element insertion in the scl1 promoter region and (ii) a nonsense mutation within the scl1 coding sequence. The scl1 transcript is drastically reduced in M3-type GAS, contrasting with a high transcription level of scl1 allele in invasive M1-type GAS. This leads to a lack of Scl1 expression in M3 strains. In contrast, while scl2 transcription and Scl2 production are elevated in M3 strains, M1 GAS lack Scl2 surface expression. M3-type strains were shown to have reduced biofilm formation on inanimate surfaces coated with cellular fibronectin and laminin, and in human skin equivalents. Repair of the nonsense mutation and restoration of Scl1 expression on M3-GAS cells, restores biofilm formation on cellular fibronectin and laminin coatings. Inactivation of scl1 in biofilm-capable M28 and M41 strains results in larger skin lesions in a mouse model, indicating that lack of Scl1 adhesin promotes bacterial spread over localized infection. These studies suggest the uniquely evolved scl1 locus in the M3-type strains, which prevents surface expression of the major Scl1 adhesin, contributed to the emergence of the invasive M3-type strains. Furthermore these studies provide insight into the molecular mechanisms mediating colonization, biofilm formation, and pathogenesis of group A streptococci.
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Affiliation(s)
- Beth A Bachert
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University Morgantown, WV, USA
| | - Soo J Choi
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University Morgantown, WV, USA
| | - Paul R LaSala
- Department of Pathology, West Virginia University Morgantown, WV, USA
| | - Tiffany I Harper
- Department of Pathology, West Virginia University Morgantown, WV, USA
| | - Dudley H McNitt
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University Morgantown, WV, USA
| | - Dylan T Boehm
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University Morgantown, WV, USA
| | - Clayton C Caswell
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University Morgantown, WV, USA
| | - Pawel Ciborowski
- Department of Pharmacology and Experimental Neuroscience, University of Nebraska Medical Center Omaha, NE, USA
| | | | - Anthony R Flores
- Section of Infectious Diseases, Department of Pediatrics, Baylor College of Medicine, Texas Children's HospitalHouston, TX, USA; Department of Pathology and Genomic Medicine, Center for Molecular and Translational Human Infectious Diseases Research, Houston Methodist Research Institute and Hospital SystemHouston, TX, USA
| | - James M Musser
- Department of Pathology and Genomic Medicine, Center for Molecular and Translational Human Infectious Diseases Research, Houston Methodist Research Institute and Hospital System Houston, TX, USA
| | - Flavia Squeglia
- Institute of Biostructures and Bioimaging, National Research Council Naples, Italy
| | - Daniela Marasco
- Department of Pharmacy, University of Naples Frederico II Naples, Italy
| | - Rita Berisio
- Institute of Biostructures and Bioimaging, National Research Council Naples, Italy
| | - Slawomir Lukomski
- Department of Microbiology, Immunology, and Cell Biology, West Virginia University Morgantown, WV, USA
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Bellulo S, Sommet J, Lévy C, Gillet Y, Hees L, Lorrot M, Gras-Le-Guen C, Craiu I, Dubos F, Minodier P, Biscardi S, Dommergues MA, Béchet S, Bidet P, Alberti C, Cohen R, Faye A. When should clinicians suspect group A streptococcus empyema in children? A multicentre case-control study in French tertiary care centres. Arch Dis Child 2016; 101:731-5. [PMID: 27073159 DOI: 10.1136/archdischild-2015-309831] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 03/22/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND The incidence of invasive group A streptococcus (GAS) infections is increasing worldwide, whereas there has been a dramatic decrease in pneumococcal invasive diseases. Few data describing GAS pleural empyema in children are available. OBJECTIVE To describe the clinical and microbiological features, management and outcome of GAS pleural empyema in children and compare them with those of pneumococcal empyema. DESIGN, SETTING AND PATIENTS Fifty children admitted for GAS pleural empyema between January 2006 and May 2013 to 8 hospitals participating in a national pneumonia survey were included in a descriptive study and matched by age and centre with 50 children with pneumococcal empyema. RESULTS The median age of the children with GAS pleural empyema was 2 (range 0.1-7.6) years. Eighteen children (36%) had at least one risk factor for invasive GAS infection (corticosteroid use and/or current varicella). On admission, 37 patients (74%) had signs of circulatory failure, and 31 (62%) had a rash. GAS was isolated from 49/50 pleural fluid samples and from one blood culture. The commonest GAS genotype was emm1 (n=17/22). Two children died (4%). Children with GAS empyema presented more frequently with a rash (p<0.01), signs of circulatory failure (p=0.01) and respiratory disorders (p=0.02) and with low leucocyte levels (p=0.04) than children with pneumococcal empyema. Intensive care unit admissions (p<0.01), drainage procedures (p=0.04) and short-term complications (p=0.01) were also more frequent in patients with GAS empyema. CONCLUSIONS Pleural empyema following varicella or presenting with rash, signs of circulatory failure and leucopenia may be due to GAS. These features should prompt the addition to treatment of an antitoxin drug, such as clindamycin.
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Affiliation(s)
| | - Julie Sommet
- INSERM, U 1123, ECEVE, CIC-EC 1426 Hôpital Robert Debré, Paris, France Department of General Pediatrics, CHU Robert Debré, Paris and University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Corinne Lévy
- ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France
| | - Yves Gillet
- ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France Department of Pediatrics, CHU Lyon-Bron and Lyon University, Hospices Civils de Lyon, Lyon, France
| | - Laure Hees
- ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France Department of Pediatrics, CHU Lyon-Bron and Lyon University, Hospices Civils de Lyon, Lyon, France
| | - Mathie Lorrot
- INSERM, U 1123, ECEVE, CIC-EC 1426 Hôpital Robert Debré, Paris, France Department of General Pediatrics, CHU Robert Debré, Paris and University Paris Diderot, Sorbonne Paris Cité, Paris, France ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France
| | - Christèle Gras-Le-Guen
- ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France Department of Pediatrics, CHU Nantes and University of Nantes, Nantes, France
| | - Irina Craiu
- ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France Department of Pediatrics, CHU Kremlin-Bicêtre, Le Kremlin Bicêtre, France
| | - François Dubos
- ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France Pediatric Emergency Unit and Infectious Diseases, CHRU Lille and University of Lille, Lille, France
| | - Philippe Minodier
- Department of Pediatrics, CHU Nord, Marseille, France ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France
| | - Sandra Biscardi
- ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France Department of Pediatrics, CHIC Créteil, Créteil, France
| | - Marie-Aliette Dommergues
- ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France Department of Pediatrics, CH Versailles, Le Chesnay, France
| | | | - Philippe Bidet
- Department of General Pediatrics, CHU Robert Debré, Paris and University Paris Diderot, Sorbonne Paris Cité, Paris, France Department of Microbiology, CHU Robert Debré, Paris, France
| | - Corinne Alberti
- INSERM, U 1123, ECEVE, CIC-EC 1426 Hôpital Robert Debré, Paris, France
| | - Robert Cohen
- ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France Unité Court Séjour, Petits Nourrissons, Service de Néonatologie, et Centre de Recherche Clinique, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Albert Faye
- INSERM, U 1123, ECEVE, CIC-EC 1426 Hôpital Robert Debré, Paris, France Department of General Pediatrics, CHU Robert Debré, Paris and University Paris Diderot, Sorbonne Paris Cité, Paris, France ACTIV, 27, rue D'Inkerman, Saint-Maur-des Fossés, France
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Aksenova AV, Shostak NA, Guseva OA. [The post-streptococcal diseases in the clinical practice]. Vestn Otorinolaringol 2016; 81:39-43. [PMID: 27213654 DOI: 10.17116/otorino201681239-43] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The authors describe various clinical forms of streptococcal infections, the pathogenetic mechanisms underlying these conditions, and peculiarities of their clinical picture. Also considered are the modern methods employed for laboratory diagnostics of streptococcal infections. The probability of the risk of development of post-streptococcal diseases in the children is evaluated. Measures for the prevention of these conditions are proposed.
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Affiliation(s)
- A V Aksenova
- N.I. Pirogov Russian National Research Medical University, Russian Ministry of Health, Moscow, Russia, 117997
| | - N A Shostak
- N.I. Pirogov Russian National Research Medical University, Russian Ministry of Health, Moscow, Russia, 117997
| | - O A Guseva
- N.I. Pirogov Russian National Research Medical University, Russian Ministry of Health, Moscow, Russia, 117997
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Frère J, Bidet P, Tapiéro B, Rallu F, Minodier P, Bonacorsi S, Bingen E, Ovetchkine P. Clinical and Microbiological Characteristics of Invasive Group A Streptococcal Infections Before and After Implementation of a Universal Varicella Vaccine Program. Clin Infect Dis 2015; 62:75-7. [PMID: 26409062 DOI: 10.1093/cid/civ793] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 08/24/2015] [Indexed: 11/14/2022] Open
Abstract
Since the introduction of the varicella vaccine to the routine immunization schedule, we have observed a 70% reduction in the rate of varicella-associated invasive group A streptococcal infections (IGASI). In the mean time, the clinical presentation of IGASI and microbiological characteristics of GAS strains have changed significantly.
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Affiliation(s)
- Julie Frère
- Infectious Diseases Division, Department of Pediatrics, Centre Hospitalo-Universitaire Sainte Justine, Université de Montréal, Québec, Canada
| | - Philippe Bidet
- Microbiology Department, Hôpital Robert Debré, Paris, France
| | - Bruce Tapiéro
- Infectious Diseases Division, Department of Pediatrics, Centre Hospitalo-Universitaire Sainte Justine, Université de Montréal, Québec, Canada
| | - Fabien Rallu
- Microbiology and Immunology Department, Centre Hospitalo-Universitaire Sainte Justine, Université de Montréal, Québec, Canada
| | - Philippe Minodier
- Pediatric Emergency, Centre Hospitalo-Universitaire Nord, Marseille, France
| | | | - Edouard Bingen
- Microbiology Department, Hôpital Robert Debré, Paris, France
| | - Philippe Ovetchkine
- Infectious Diseases Division, Department of Pediatrics, Centre Hospitalo-Universitaire Sainte Justine, Université de Montréal, Québec, Canada
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Abstract
We analyzed characteristics of 86 Group A streptococcal bacteremia cases at Boston Children's Hospital from 1992 to 2012. Twenty-three percent of children had severe disease, using intensive care unit admission (18), disability (7) or death (2) as indicators. Children with bacteremia without a source (30% of cases) were less likely to have severe disease than children with focal infections in adjusted models.
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Ovetchkine P, Bidet P, Minodier P, Frère J, Bingen E. Épidémiologie des infections invasives à streptocoques du groupe A dans les pays industrialisés : l’exemple des fasciites nécrosantes au Canada. Arch Pediatr 2014; 21 Suppl 2:S73-7. [DOI: 10.1016/s0929-693x(14)72264-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Éditorial. Arch Pediatr 2014; 21 Suppl 2:S51-3. [DOI: 10.1016/s0929-693x(14)72260-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Deceuninck G, Quach C, Panagopoulos M, Thibeault R, Côté-Boileau T, Tapiéro B, Coïc L, De Wals P, Ovetchkine P. Pediatric Pleural Empyema in the Province of Quebec: Analysis of a 10-Fold Increase Between 1990 and 2007. J Pediatric Infect Dis Soc 2014; 3:119-26. [PMID: 26625364 DOI: 10.1093/jpids/pit075] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 08/19/2013] [Indexed: 11/13/2022]
Abstract
BACKGROUND Although the frequency of pneumonia has decreased over time, an increase in pleural empyema has been observed in different settings worldwide. This study assessed the epidemiology of community-acquired pediatric pleural empyema in the province of Quebec through validation of cases found in a hospitalization discharge database. METHODS We used the national administrative database of hospitalization to identify children (6 months-14 years) hospitalized for pleural empyema or pleural effusion with drainage from January 1990 until December 2007 and reviewed their medical charts. Patients with pleural effusion secondary to chest trauma, thoracic surgery, malignancies, cardiac failure, or metabolic disorders were excluded. RESULTS Predictive positive value (PPV) of empyema code in any position among discharge diagnostics in the administrative database was 86.5% (95% confidence interval: 81.9%-90.3%). After chart revision, 292 met the inclusion criteria. Age-adjusted incidence of pleural empyema in the pediatric population increased from 0.23 in 1990 to 4.01/100,000 person-years in 2007. A bacterial pathogen was identified in 46.5%; Streptococcus pneumoniae (Sp) (42%) and S pyogenes (30%) were most frequent. There was no obvious change in the PPV and proportions of children with chronic disease or asthma and in identified pathogens over time, but an increase in pre-admission respiratory symptoms duration (from 3.8 days to 5.7) and nonsteroidal anti-inflammatory drug use (from 0% to 19%) was observed. CONCLUSIONS From 1990 to 2007, we observed a 10-fold increase in the incidence of pediatric hospitalizations associated with pleural empyema. This increase preceded the introduction of a pneumococcal conjugated vaccine program in Quebec. Sp remained the major pathogen identified.
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Affiliation(s)
| | - Caroline Quach
- Division of Infectious Diseases, Department of Pediatrics and Medical Microbiology, The Montreal Children's Hospital and McGill University, and
| | - Markos Panagopoulos
- Division of Infectious Diseases, Department of Pediatrics, CHU-Sainte-Justine and University of Montreal, Montreal, Quebec, Canada
| | - Roseline Thibeault
- Division of Infectious Diseases, Department of Pediatrics, CHU Quebec and Laval University, Quebec City, Quebec, Canada
| | | | - Bruce Tapiéro
- Division of Infectious Diseases, Department of Pediatrics, CHU-Sainte-Justine and University of Montreal, Montreal, Quebec, Canada
| | - Léna Coïc
- Division of Infectious Diseases, Department of Pediatrics, CHU-Sainte-Justine and University of Montreal, Montreal, Quebec, Canada
| | - Philippe De Wals
- Department of Social and Preventive Medicine, Laval University, Quebec City, Quebec, Canada
| | - Philippe Ovetchkine
- Division of Infectious Diseases, Department of Pediatrics, CHU-Sainte-Justine and University of Montreal, Montreal, Quebec, Canada
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Fernandez I, Brito RM, Bidet P, Rallu F, Laferrière C, Ovetchkine P, Le Deist F. Invasive group A Streptococcus disease in French-Canadian children is not associated with a defect in MyD88/IRAK4-pathway. Allergy Asthma Clin Immunol 2014; 10:9. [PMID: 24499202 PMCID: PMC3927219 DOI: 10.1186/1710-1492-10-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 12/22/2013] [Indexed: 01/09/2023] Open
Abstract
Background Beta-hemolytic Group A Streptococcus invasive disease (iGASd) has been subject to intense research since its re-emergence in the late 1980s. In Quebec, an increase in the number of severe iGASd cases has recently been observed. Because of the inter-individual variability in the severity of iGASd, a hereditary predisposition to invasive disease can be suspected. Given that iGASd occurs in MyD88- and IRAK4-deficient patients, although rarely, the increasing frequency of iGASd in the population of French-Canadian children may be associated with a deficiency in the host’s innate immune response. Methods In this report, we assessed the influence of: (i) bacterial genotype and virulence factors, (ii) immune-cellular features, and (iii) Myd88/IRAK4-dependent response to GAS in vitro on the susceptibility to iGASd in a paediatric cohort of 16 children: 11 French-Canadian and 5 from diverse origin. Findings GAS virulence factors and genotype are not implicated in the susceptibility toward iGASd, and cellular and MyD88/IRAK4 deficiencies are excluded in our patients. Conclusions Although it has been shown that the MyD88/IRAK4-dependent signal is involved in the response to invasive GAS, our data indicates that a MyD88/IRAK4-mediated signalling defect is not the main factor responsible for the susceptibility to severe iGASd in a paediatric population from the province of Quebec.
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Affiliation(s)
- Isabel Fernandez
- Department of Microbiology, Infectiology and Immunology, CHU Sainte-Justine and University of Montreal, Montreal (Quebec), Canada.
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14
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Abstract
The spectrum of illnesses caused by group A streptococcus (GAS) includes invasive infections, noninvasive infections, and noninfectious complications. Increasingly virulent infections associated with high morbidity and mortality have been observed since the late 1980s and continue to be prevalent in North America and worldwide. Penicillin remains the therapy of choice, with the addition of clindamycin recommended in high risk cases. Early recognition of GAS as the cause of these serious clinical syndromes is critical for timely administration of appropriate therapy. In this review, the pathophysiology, clinical manifestations, and treatment of invasive GAS infections are discussed.
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Affiliation(s)
- Christopher J Wong
- Division of General Internal Medicine, Department of Medicine, University of Washington, 4245 Roosevelt Way Northeast, Box 354760, Seattle, WA 98105, USA.
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15
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Laupland K. Incidence of bloodstream infection: a review of population-based studies. Clin Microbiol Infect 2013; 19:492-500. [DOI: 10.1111/1469-0691.12144] [Citation(s) in RCA: 202] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 10/31/2012] [Accepted: 12/22/2012] [Indexed: 11/29/2022]
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16
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Clinical and microbiologic characteristics of invasive Streptococcus pyogenes infections in north and south India. J Clin Microbiol 2012; 50:1626-31. [PMID: 22357508 DOI: 10.1128/jcm.06697-11] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The lack of epidemiologic data on invasive Streptococcus pyogenes infections in many developing countries is concerning, as S. pyogenes infections are commonly endemic in these areas. Here we present the results of the first prospective surveillance study of invasive Streptococcus pyogenes infections in India. Fifty-four patients with invasive S. pyogenes infections were prospectively enrolled at two study sites, one in the north and one in the south of India. Sterile-site isolates were collected, and clinical information was documented using a standardized questionnaire. Available acute-phase sera were tested for their ability to inhibit superantigens produced by the patient's own isolate using a cell-based neutralizing assay. The most common clinical presentations were bacteremia without focus (30%), pneumonia (28%), and cellulitis (17%). Only two cases of streptococcal toxic shock syndrome and no cases of necrotizing fasciitis were identified. Characterization of the isolates revealed great heterogeneity, with 32 different emm subtypes and 29 different superantigen gene profiles being represented among the 49 sterile-site isolates. Analyses of acute-phase sera showed that only 20% of the cases in the north cohort had superantigen-neutralizing activity in their sera, whereas 50% of the cases from the south site had neutralizing activity. The results demonstrate that there are important differences in both clinical presentation and strain characteristics between invasive S. pyogenes infections in India and invasive S. pyogenes infections in Western countries. The findings underscore the importance of epidemiologic studies on streptococcal infections in India and have direct implications for current vaccine developments.
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Schwartz J, Pavlova S, Kolokythas A, Lugakingira M, Tao L, Miloro M. Streptococci-human papilloma virus interaction with ethanol exposure leads to keratinocyte damage. J Oral Maxillofac Surg 2011; 70:1867-79. [PMID: 22079067 DOI: 10.1016/j.joms.2011.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Revised: 08/02/2011] [Accepted: 08/03/2011] [Indexed: 11/16/2022]
Abstract
PURPOSE Ethanol, human papilloma virus (HPV), and poor oral hygiene are risk factors that have been attributed to oral carcinogenesis. Streptococci sp and HPV infections are common in the head and neck, often associated with sexual activity. Although HPV is linked to head and neck squamous cell carcinoma, it is unclear whether there is a similar role for Streptococci sp. This cell study examines whether Streptococci sp and HPV-16 with exposure to ethyl alcohol (ETOH) can act as cofactors in the malignant transformation of oral keratinocytes. MATERIALS AND METHODS ETOH (0.1%-20% vol/vol) was used to investigate Streptococci sp attachment with immortalized E6-expressing HPV/HOK-16B cells, human oral buccal keratinocytes, and foreskin keratinocytes. Streptococci sp (Streptococci mutans [LT11]) and various strains of acetaldehyde (AA) producer and nonproducer Streptococcus salivarius (110-1, 109-2, 101-7, and 107-1) and a lactic acid producer bacterium, Lactobacillus rhamnosus (24-1 and 25-2), were examined for interactions with keratinocytes by use of a green dye (percent of cells with colonies after 24 hours). Carcinogens, AA, malondialdehyde, DNA damage, and proliferation (5'-bromo-2-deoxyuridine) among keratinocytes were also quantified. RESULTS AA and malondialdehyde production from permissible Streptococci sp significantly increased with attachment to keratinocytes, whereas L rhamnosus did not significantly attach to keratinocytes. This attachment was associated with enhanced levels of AA adduct formation, proliferation (5'-bromo-2-deoxyuridine incorporation), and enhanced migration through integrin-coated basement membrane by HPV oral keratinocytes, which are characteristics of a malignant phenotype. CONCLUSIONS These cell studies suggest that oral Streptococci sp and HPV (HPV-16) cooperate to transform oral keratinocytes after low-level ETOH (1%) exposure. These results appear to suggest a significant clinical interaction, but further validation is warranted.
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Affiliation(s)
- Joel Schwartz
- Department of Oral Medicine and Diagnostic Sciences, and Member, University of Illinois Cancer Center, College of Dentistry, University of Illinois at Chicago, Chicago, IL 60612, USA.
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Chen IC, Li WC, Hong YC, Shie SS, Fann WC, Hsiao CT. The microbiological profile and presence of bloodstream infection influence mortality rates in necrotizing fasciitis. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 15:R152. [PMID: 21693053 PMCID: PMC3219026 DOI: 10.1186/cc10278] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Revised: 05/27/2011] [Accepted: 06/21/2011] [Indexed: 11/23/2022]
Abstract
Introduction Necrotizing fasciitis (NF) is a life threatening infectious disease with a high mortality rate. We carried out a microbiological characterization of the causative pathogens. We investigated the correlation of mortality in NF with bloodstream infection and with the presence of co-morbidities. Methods In this retrospective study, we analyzed 323 patients who presented with necrotizing fasciitis at two different institutions. Bloodstream infection (BSI) was defined as a positive blood culture result. The patients were categorized as survivors and non-survivors. Eleven clinically important variables which were statistically significant by univariate analysis were selected for multivariate regression analysis and a stepwise logistic regression model was developed to determine the association between BSI and mortality. Results Univariate logistic regression analysis showed that patients with hypotension, heart disease, liver disease, presence of Vibrio spp. in wound cultures, presence of fungus in wound cultures, and presence of Streptococcus group A, Aeromonas spp. or Vibrio spp. in blood cultures, had a significantly higher risk of in-hospital mortality. Our multivariate logistic regression analysis showed a higher risk of mortality in patients with pre-existing conditions like hypotension, heart disease, and liver disease. Multivariate logistic regression analysis also showed that presence of Vibrio spp in wound cultures, and presence of Streptococcus Group A in blood cultures were associated with a high risk of mortality while debridement > = 3 was associated with improved survival. Conclusions Mortality in patients with necrotizing fasciitis was significantly associated with the presence of Vibrio in wound cultures and Streptococcus group A in blood cultures.
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Affiliation(s)
- I-Chuan Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, No,6, W, Sec,, Jiapu Rd,, Puzih City, Chiayi County 613, Taiwan
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Olsen RJ, Ashraf M, Gonulal VE, Ayeras AA, Cantu C, Shea PR, Carroll RK, Humbird T, Greaver JL, Swain JL, Chang E, Ragasa W, Jenkins L, Lally KP, Blasdel T, Cagle P, Musser JM. Lower respiratory tract infection in cynomolgus macaques (Macaca fascicularis) infected with group A Streptococcus. Microb Pathog 2010; 49:336-47. [DOI: 10.1016/j.micpath.2010.06.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Revised: 06/28/2010] [Accepted: 06/30/2010] [Indexed: 10/19/2022]
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20
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Sex-related differences in gene expression following Coxiella burnetii infection in mice: potential role of circadian rhythm. PLoS One 2010; 5:e12190. [PMID: 20730052 PMCID: PMC2921390 DOI: 10.1371/journal.pone.0012190] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2010] [Accepted: 07/22/2010] [Indexed: 12/20/2022] Open
Abstract
Background Q fever, a zoonosis due to Coxiella burnetii infection, exhibits sexual dimorphism; men are affected more frequently and severely than women for a given exposure. Here we explore whether the severity of C. burnetii infection in mice is related to differences in male and female gene expression profiles. Methodology/Principal Findings Mice were infected with C. burnetii for 24 hours, and gene expression was measured in liver cells using microarrays. Multiclass analysis identified 2,777 probes for which expression was specifically modulated by C. burnetti infection. Only 14% of the modulated genes were sex-independent, and the remaining 86% were differentially expressed in males and females. Castration of males and females showed that sex hormones were responsible for more than 60% of the observed gene modulation, and this reduction was most pronounced in males. Using functional annotation of modulated genes, we identified four clusters enriched in males that were related to cell-cell adhesion, signal transduction, defensins and cytokine/Jak-Stat pathways. Up-regulation of the IL-10 and Stat-3 genes may account for the high susceptibility of men with Q fever to C. burnetii infection and autoantibody production. Two clusters were identified in females, including the circadian rhythm pathway, which consists of positive (Clock, Arntl) and negative (Per) limbs of a feedback loop. We found that Clock and Arntl were down-modulated whereas Per was up-regulated; these changes may be associated with efficient bacterial elimination in females but not in males, in which an exacerbated host response would be prominent. Conclusion This large-scale study revealed for the first time that circadian rhythm plays a major role in the anti-infectious response of mice, and it provides a new basis for elucidating the role of sexual dimorphism in human infections.
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Lee GM, Salomon JA, Gay C, Hammitt JK. Preferences for health outcomes associated with Group A Streptococcal disease and vaccination. Health Qual Life Outcomes 2010; 8:28. [PMID: 20226042 PMCID: PMC2848145 DOI: 10.1186/1477-7525-8-28] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2009] [Accepted: 03/12/2010] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A 26-valent Group A Streptococcus (GAS) vaccine candidate has been developed that may provide protection against pharyngitis, invasive disease and rheumatic fever. However, recommendations for the use of a new vaccine must be informed by a range of considerations, including parents' preferences for different relevant health outcomes. Our objectives were to: (1) describe parent preferences for GAS disease and vaccination using willingness-to-pay (WTP) and time trade-off (TTO) methods; and (2) understand how parents' implied WTP for a quality-adjusted life year (QALY) gained might vary depending on the particular health outcome considered (e.g. averted GAS disease vs. vaccine adverse events). METHODS Telephone interviews were conducted with parents of children diagnosed with GAS pharyngitis at 2 pediatric practice sites in the Boston metropolitan area. WTP and TTO (trading parental longevity for child's health) questions for 2 vaccine and 4 disease-associated health states were asked using a randomly selected opening bid, followed by a 2nd bid and a final open-ended question about the amount willing to pay or trade. Descriptive analyses included medians and interquartile ranges for WTP and TTO estimates. The Wilcoxon signed-rank test was used to assess differences in WTP/QALY values for vaccine adverse events vs. disease states. RESULTS Of 119 respondents, 100 (84%) and 96 (81%) provided a complete set of responses for WTP and TTO questions, respectively. The median WTP and discounted (at 3% per year) TTO values to avoid each health state were as follows: local reaction, $30, 0.12 days; systemic reaction, $50, 0.22 days; impetigo, $75, 1.25 days; strep throat, $75, 2.5 days; septic arthritis, $1,000, 6.6 days; and toxic shock syndrome, $3,000, 31.0 days. The median WTP/QALY was significantly higher for vaccine adverse events (approximately $60,000/QALY) compared to disease states ($18,000 to $36,000/QALY). CONCLUSIONS Parents strongly prefer to prevent GAS disease in children compared to vaccine adverse events. However, implied WTP/QALY ratios were higher for the prevention of vaccine adverse events. Regret for errors of commission vs. omission may differ and should be considered by vaccine policymakers.
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Affiliation(s)
- Grace M Lee
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, Boston, MA 02215, USA
- Division of Infectious Diseases, Department of Medicine, and Department of Laboratory Medicine, Children's Hospital Boston, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Joshua A Salomon
- Department of Global Health and Population, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA 02115, USA
| | - Charlene Gay
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, Boston, MA 02215, USA
| | - James K Hammitt
- Center for Risk Analysis and Department of Health Policy and Management, Harvard School of Public Health, 718 Huntington Avenue, Boston, MA 02115, USA
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Lamagni TL, Neal S, Keshishian C, Powell D, Potz N, Pebody R, George R, Duckworth G, Vuopio-Varkila J, Efstratiou A. Predictors of death after severe Streptococcus pyogenes infection. Emerg Infect Dis 2009; 15:1304-7. [PMID: 19751599 DOI: 10.3201/eid1508.090264] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
An evaluation of the relative importance of host and pathogen factors on the survival rate of patients with invasive Streptococcus pyogenes infection found a number of clinical and demographic factors to be associated with risk for death. Some evidence suggested a seasonal pattern to patient survival rate.
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Clinical and microbiologic characteristics of group A streptococcal necrotizing fasciitis in children. Pediatr Infect Dis J 2009; 28:541-3. [PMID: 19504739 DOI: 10.1097/inf.0b013e318195bb10] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
An increase in the incidence of Group A streptococcal necrotizing fasciitis has recently been observed in Montréal, Canada. Clinical features of children hospitalized for invasive Group A streptococcal infections and various virulence factor genes of the bacteria were concomitantly analyzed. It was determined that varicella and presence of speC gene in group A streptococcal strains were associated with necrotizing fasciitis.
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Abstract
Streptococcal A infections are reemerging as a dangerous clinical problem. This particular infection is usually a problem for the postpartum mother and not usually associated with fetal or neonatal infections. Maternal morbidity and mortality are overwhelming when compared with other maternal infections. Historically, group A streptococcus was the cause of epidemic postpartum sepsis prior to the advent of proper hand-washing techniques. Currently, transmission can occur directly from a colonized healthcare provider, other patients, or a community-acquired source. The Joint Commission and the International Surviving Sepsis Campaign have placed patient safety and early recognition and treatment of sepsis as major initiatives to improving patient outcomes.
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Rantala S, Vuopio-Varkila J, Vuento R, Huhtala H, Syrjänen J. Predictors of mortality in beta-hemolytic streptococcal bacteremia: a population-based study. J Infect 2009; 58:266-72. [PMID: 19261333 DOI: 10.1016/j.jinf.2009.01.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Revised: 01/11/2009] [Accepted: 01/19/2009] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Several factors associated with mortality in Lancefield group A beta-hemolytic streptococcal bacteremia have been described in population-based surveillance studies, whereas such reports on group B, C, and G streptococcal are scant. METHODS In this population-based study all 314 episodes of beta-hemolytic streptococcal bacteremia in adult patients in the Pirkanmaa area, Finland, during the 10-year period 1995-2004 were retrospectively reviewed. RESULTS The 30-day case-fatality rate was 13%, being highest in group C (22%); in group A it was 15%, in group B 7%, and in group G 15%. Confusion, unconsciousness and dyspnea as the first sign or symptom were associated with increased case-fatality, while fever seemed to be a protecting factor for death. Alcoholism and ultimately or rapidly fatal underlying disease were significantly associated with increased case-fatality. Among infections of the skin and soft-tissues, necrotizing fasciitis had the highest risk of death (38%), while patients with cellulitis had a case-fatality of 8%. A history of previous cellulitis seemed to protect against death (case-fatality of 3% as compared to 16% among those without such a history (p=0.014)). CONCLUSION A history of previous cellulitis seemed to be a protecting factor against death. Fever was also associated with a good prognosis.
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Affiliation(s)
- Sari Rantala
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.
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Abstract
Group A streptococci, also known as Streptococcus pyogenes, is a common cause of infection in the pediatric population. Recently, the incidence of streptococcal toxic shock syndrome, a serious and often deadly manifestation of group A streptococci infection, has increased. Streptococcal toxic shock syndrome often presents with complaints of musculoskeletal pain, which frequently leads to early involvement of an orthopaedic surgeon. In this case report, we present a 5-year-old child who presented with a septic arthritis of the knee, whose final diagnosis was streptococcal toxic shock syndrome. A review of the literature and the aspects of this case report emphasize the emergent nature of streptococcal joint infections and the judicious use of orthopaedic intervention in such patients.
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Lamagni TL, Neal S, Keshishian C, Alhaddad N, George R, Duckworth G, Vuopio-Varkila J, Efstratiou A. Severe Streptococcus pyogenes infections, United Kingdom, 2003-2004. Emerg Infect Dis 2008; 14:202-9. [PMID: 18258111 PMCID: PMC2600190 DOI: 10.3201/eid1402.070888] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
As part of a Europe-wide initiative to explore current epidemiologic patterns of severe disease caused by Streptococcus pyogenes, the United Kingdom undertook enhanced population-based surveillance during 2003-2004. A total of 3,775 confirmed cases of severe S. pyogenes infection were identified over 2 years, 3.33/100,000 population, substantially more than previously estimated. Skin/soft tissue infections were the most common manifestation (42%), followed by respiratory tract infections (17%). Injection drug use was identified as a risk factor for 20% of case-patients. One in 5 infected case-patients died within 7 days of diagnosis; the highest mortality rate was for cases of necrotizing fasciitis (34%). Nonsteroidal antiinflammatory drugs, alcoholism, young age, and infection with emm/M3 types were independently associated with increased risk for streptococcal toxic shock syndrome. Understanding the pattern of these diseases and predictors of poor patient outcome will help with identification and assessment of the potential effect of targeted interventions.
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DeVita MD, Wadhera RK, Theis ML, Ingham SC. Assessing the potential of Streptococcus pyogenes and Staphylococcus aureus transfer to foods and customers via a survey of hands, hand-contact surfaces and food-contact surfaces at foodservice facilities. ACTA ACUST UNITED AC 2007. [DOI: 10.1111/j.1745-4506.2007.00049.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Plana Fernández M, López Gil A, Gomà Brufau AR, Solé Mir E, Bringué Espuny X. Enfermedad invasiva por Streptococcus pyogenes en lactante sano de 38 días. An Pediatr (Barc) 2007; 66:540-1. [PMID: 17517211 DOI: 10.1157/13102521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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30
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Batalis NI, Caplan MJ, Schandl CA. Acute Deaths in Nonpregnant Adults Due to Invasive Streptococcal Infections. Am J Forensic Med Pathol 2007; 28:63-8. [PMID: 17325468 DOI: 10.1097/01.paf.0000248775.34108.da] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Streptococcal organisms, part of the normal human bacterial flora, occasionally become infectious pathogens responsible for a wide array of clinical syndromes, ranging from mild pharyngitis to death. Notably, infections due to group A and group B beta-hemolytic strains are well known for causing invasive disease leading to death. These deaths, while often suspected clinically, occasionally are not diagnosed until autopsy. We present 3 rapid deaths, with very different presentations, due to streptococcal infection. Two decedents experienced sudden deaths due to pneumonia and severe meningoencephalitis caused by group B beta-hemolytic streptococcal infection, a common cause of neonatal meningitis but only rarely reported in nonpregnant adults. The final case involves a 69-year-old male who presented to the emergency room with a complaint of shoulder pain but over the next several hours developed signs of necrotizing fasciitis, became septic, and died. While antemortem cultures were negative, owing to antibiotic administration, postmortem cultures of bone and deep soft tissue were positive for group A beta-hemolytic Streptococcus sp. Acute and sudden deaths due to infectious etiology represent an uncommon yet well-documented occurrence. The importance of appropriate postmortem cultures in these situations and a review of the literature will be discussed.
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Affiliation(s)
- Nick I Batalis
- Medical University of South Carolina, Forensic Section, Charleston, South Carolina, USA.
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31
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Morbidity and Mortality of Patients With Invasive Group A Streptococcal Infections Admitted to the ICU. Chest 2006. [DOI: 10.1016/s0012-3692(15)50887-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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32
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Al-Kaabi N, Solh Z, Pacheco S, Murray L, Gaboury I, Le Saux N. A Comparison of group A Streptococcus versus Streptococcus pneumoniae pneumonia. Pediatr Infect Dis J 2006; 25:1008-12. [PMID: 17072122 DOI: 10.1097/01.inf.0000243198.63255.c1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND St reptococcus pyogenes is an uncommon cause of community-acquired pneumonia in children. Further, its clinical course in comparison to pneumonia caused by Streptococcus pneumonia has not been previously highlighted. METHODS We reviewed medical records of children 0-18 years of age from April 1983 to April 2005, with discharge diagnoses of invasive disease caused by group A streptococcus (GAS) (Streptococcus pyogenes), or Streptococcus pneumonia (SP) or pneumonia. Data were extracted from the charts, and a comparison of clinical characteristics between the 2 etiologies was performed. Confirmed disease required blood or pleural fluid isolates. Patients with single isolates of GAS in tracheobronchial secretions or sputum were classified as having presumed disease caused by GAS. Patients with confirmed disease due to GAS and SP were compared with respect to clinical characteristics. RESULTS Of 103 patients with invasive GAS disease, 12 (11.6%) had confirmed GAS lobar pneumonia. In addition 7 patients had presumed GAS pneumonia. There were 54 patients with confirmed SP pneumonia. Most children who had GAS pneumonia were healthy and recovered completely. Compared with patients with confirmed SP pneumonia, those with confirmed GAS pneumonia had more frequent and larger effusions, more culture positive effusions, had prolonged fever, and had longer hospitalizations. There was not an increasing trend to GAS pneumonia over the 22-year period. There was not a predominant serotype responsible for the pneumonias. CONCLUSIONS Lobar GAS pneumonia represents approximately 11% of all cases of invasive disease in this institution during a 22-year period. Compared with patients with SP pneumonia, it appears to cause more effusions and morbidity. The organism is also more frequently recovered from pleural fluid.
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Affiliation(s)
- Nawal Al-Kaabi
- Chalmers Research Group, Statistical Division, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Ozkaya G, Shorbagi A, Ulger Z, Saglam A, Aybar M, Sardan YC, Uzun O. Invasive group A streptococcal infection with pancarditis caused by a new emm-type 12 allele of Streptococcus pyogenes. J Infect 2005; 53:e1-4. [PMID: 16364444 DOI: 10.1016/j.jinf.2005.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2005] [Revised: 09/30/2005] [Accepted: 10/04/2005] [Indexed: 11/19/2022]
Abstract
Throughout the 1980s, a progressive increase in the incidence of Streptococcus pyogenes-related invasive infections has occurred. It has been suggested that a host-related immunogenetic background, as well as bacterial virulence factors may play an important role in the outcome of streptococcal infections. Here, we present the first case of pancarditis in the literature caused by direct bacterial invasion due to a new emm-type 12 allele of S. pyogenes in an immunocompetent patient. The pathogenesis of this invasive infection, as well as predictors of poor prognosis are discussed.
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Affiliation(s)
- Gülşen Ozkaya
- Section of Infectious Diseases Unit, Hacettepe University School of Medicine, Ankara, Turkey.
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