1
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Zou Z, Singh P, Pinkner JS, Obernuefemann CLP, Xu W, Nye TM, Dodson KW, Almqvist F, Hultgren SJ, Caparon MG. Dihydrothiazolo ring-fused 2-pyridone antimicrobial compounds treat Streptococcus pyogenes skin and soft tissue infection. SCIENCE ADVANCES 2024; 10:eadn7979. [PMID: 39093975 PMCID: PMC11296344 DOI: 10.1126/sciadv.adn7979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 06/27/2024] [Indexed: 08/04/2024]
Abstract
We have developed GmPcides from a peptidomimetic dihydrothiazolo ring-fused 2-pyridone scaffold that has antimicrobial activities against a broad spectrum of Gram-positive pathogens. Here, we examine the treatment efficacy of GmPcides using skin and soft tissue infection (SSTI) and biofilm formation models by Streptococcus pyogenes. Screening our compound library for minimal inhibitory (MIC) and minimal bactericidal (MBC) concentrations identified GmPcide PS757 as highly active against S. pyogenes. Treatment of S. pyogenes biofilm with PS757 revealed robust efficacy against all phases of biofilm formation by preventing initial biofilm development, ceasing biofilm maturation and eradicating mature biofilm. In a murine model of S. pyogenes SSTI, subcutaneous delivery of PS757 resulted in reduced levels of tissue damage, decreased bacterial burdens, and accelerated rates of wound healing, which were associated with down-regulation of key virulence factors, including M protein and the SpeB cysteine protease. These data demonstrate that GmPcides show considerable promise for treating S. pyogenes infections.
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Affiliation(s)
- Zongsen Zou
- Department of Molecular Microbiology, Center for Women’s Infectious Disease Research, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Pardeep Singh
- Department of Chemistry, Umeå University, SE-90187 Umeå, Sweden
| | - Jerome S. Pinkner
- Department of Molecular Microbiology, Center for Women’s Infectious Disease Research, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Chloe L. P. Obernuefemann
- Department of Molecular Microbiology, Center for Women’s Infectious Disease Research, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Wei Xu
- Department of Molecular Microbiology, Center for Women’s Infectious Disease Research, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Taylor M. Nye
- Department of Molecular Microbiology, Center for Women’s Infectious Disease Research, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Karen W. Dodson
- Department of Molecular Microbiology, Center for Women’s Infectious Disease Research, Washington University School of Medicine, St. Louis, MO 63110, USA
| | | | - Scott J. Hultgren
- Department of Molecular Microbiology, Center for Women’s Infectious Disease Research, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Michael G. Caparon
- Department of Molecular Microbiology, Center for Women’s Infectious Disease Research, Washington University School of Medicine, St. Louis, MO 63110, USA
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2
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Gonzales Y Tucker RD, Addepalli A. Fever and Rash. Emerg Med Clin North Am 2024; 42:303-334. [PMID: 38641393 DOI: 10.1016/j.emc.2024.01.005] [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: 04/21/2024]
Abstract
Infectious causes of fever and rash pose a diagnostic challenge for the emergency provider. It is often difficult to discern rashes associated with rapidly progressive and life-threatening infections from benign exanthems, which comprise the majority of rashes seen in the emergency department. Physicians must also consider serious noninfectious causes of fever and rash. A correct diagnosis depends on an exhaustive history and head-to-toe skin examination as most emergent causes of fever and rash remain clinical diagnoses. A provisional diagnosis and immediate treatment with antimicrobials and supportive care are usually required prior to the return of confirmatory laboratory testing.
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Affiliation(s)
- Richard Diego Gonzales Y Tucker
- Department of Emergency Medicine, University of California San Francisco, Box 0209, 505 Parnassus Avenue, San Francisco, CA 94143, USA; Department of Emergency Medicine, Alameda Health System - Wilma Chan Highland Hospital, 1411 E 31st Street, Oakland, CA 94602, USA.
| | - Aravind Addepalli
- Department of Emergency Medicine, University of California San Francisco, Box 0209, 505 Parnassus Avenue, San Francisco, CA 94143, USA
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3
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Hung TY, Phuong LK, Grobler A, Tong SYC, Freeth P, Pelenda A, Gibney KB, Steer AC. Antibiotics to eradicate Streptococcus pyogenes pharyngeal carriage in asymptomatic children and adults: A systematic review. J Infect 2024; 88:106104. [PMID: 38360357 DOI: 10.1016/j.jinf.2024.01.003] [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: 11/25/2023] [Accepted: 01/14/2024] [Indexed: 02/17/2024]
Abstract
Streptococcus pyogenes (S. pyogenes) is a Gram-positive bacteria which causes a spectrum of diseases ranging from asymptomatic infection to life-threatening sepsis. Studies report up to 2000 times greater risk of invasive S. pyogenes disease in close contacts of index cases within 30-days of symptom onset. Despite this, there is variability in the management of asymptomatic carriage of S. pyogenes and those at risk of secondary cases of invasive S. pyogenes infection. OBJECTIVE Our systematic review assessed the efficacy of different antibiotic regimens used for eradication of S. pyogenes from the pharynx in asymptomatic individuals. METHODS We searched Pubmed, EMBASE (1974-), OVID Medline (1948-) and the Cochrane CENTRAL registry. We included randomised controlled trials (RCTs) with asymptomatic participants with >50% with pharyngeal cultures positive with S. pyogenes at baseline. Only studies with microbiological methods including culture (+/- polymerase chain reaction, PCR) were included. We included studies published in English. Each included study was assessed by two independent reviewers for data extraction and risk of bias. RESULTS Of 1166 unique records identified, three RCTs were included in the review. Two of the three included RCTs found oral clindamycin for 10-days was the most efficacious regimen, compared to intramuscular benzathine penicillin G followed by 4 days of oral rifampicin, or monotherapy using benzathine penicillin, phenoxymethylpenicillin or erythromycin. Two RCTs were assessed as being at high risk of bias, with the third study demonstrating low/some risk of bias. CONCLUSIONS Current available evidence for the optimal antibiotic in eradicating pharyngeal S. pyogenes carriage is limited. Future RCTs should include penicillin, first-generation cephalosporins, rifampicin, macrolides (such as azithromycin) and clindamycin.
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Affiliation(s)
- Te-Yu Hung
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; Department of Paediatrics, Royal Darwin Hospital, Top End Health Service, Northern Territory, Australia.
| | - Linny K Phuong
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia; Tropical Diseases, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Anneke Grobler
- Tropical Diseases, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Steven Y C Tong
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Pippin Freeth
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Asika Pelenda
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Katherine B Gibney
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.
| | - Andrew C Steer
- Infectious Diseases Unit, Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia; Tropical Diseases, Murdoch Children's Research Institute, Parkville, Victoria, Australia
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4
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Singer R, Abu Sin M, Tenenbaum T, Toepfner N, Berner R, Buda S, Schlaberg J, Schönfeld V, Reinacher U, van der Linden M, Claus H, Lâm TT, Schneider M, Noll I, Haller S, von Laer A. The Increase in Invasive Bacterial Infections With Respiratory Transmission in Germany, 2022/2023. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:114-120. [PMID: 38229497 PMCID: PMC11019759 DOI: 10.3238/arztebl.m2023.0261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 11/23/2023] [Accepted: 11/23/2023] [Indexed: 01/18/2024]
Abstract
BACKGROUND In late 2022, health care institutions in Germany reported an unusual number of severe, invasive bacterial infections in association with a high incidence of viral respiratory infections. METHODS We analyzed routine data on invasive infections due to Haemophilus influenzae, Neisseria meningitidis, Staphylococcus aureus, Streptococcus pneumoniae, and Streptococcus pyogenes (2017-2023) from a voluntary, laboratory-based surveillance system involving continuously participating facilities providing diagnostic routine data that cover approximately one-third of the German population. RESULTS In the first quarter (Q1) of 2023, the number of invasive S. pyogenes isolates rose by 142% (n = 837 vs. mean Q1/2017-2019 = 346, 95% CI [258; 434]), while the number of H. influenzae isolates rose by 90% (n = 209 in Q1/2023 vs. mean Q1/2017-2019 = 110, 95% CI [79; 142]), compared to pre-pandemic seasonal peak values. The number of invasive S. pneumoniae isolates was high in two quarters (n = 1732 in Q4/2022 und Q1/2023). Adults aged 55 and older and children younger than 5 years were most affected by invasive H. influenzae, S. pneumoniae, and S. pyogenes infections. N. meningitidis was most commonly found in children under age 5. CONCLUSION The reason for the marked rise in invasive bacterial infections may be an increased circulation of respiratory pathogens and elevated susceptibility in the population after relaxation of the measures taken to prevent COVID-19 infection. Coinfections with respiratory viruses may have reinforced this effect. We recommend continuous surveillance, preventive measures such as raising awareness about invasive bacterial diseases, and vaccination as recommended by the German Standing Committee on Vaccinations (STIKO).
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Affiliation(s)
- Regina Singer
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin
- Postgraduate Training in Applied Epidemiology, Robert Koch Institute, Berlin
- European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Muna Abu Sin
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin
| | - Tobias Tenenbaum
- Department of Pediatrics, Sana Hospital Lichtenberg, Academic Teaching Hospital of the Charité, Berlin
| | - Nicole Toepfner
- Department of Pediatrics, Carl Gustav Carus University Hospital and Faculty of Medicine, Technical University of Dresden
| | - Reinhard Berner
- Department of Pediatrics, Carl Gustav Carus University Hospital and Faculty of Medicine, Technical University of Dresden
| | - Silke Buda
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin
| | - Johanna Schlaberg
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin
| | - Viktoria Schönfeld
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin
| | - Ulrich Reinacher
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin
| | - Mark van der Linden
- Institute for Medical Microbiology, University Hospital, RWTH Aachen University, Aachen
| | - Heike Claus
- National Reference Center for Meningococci and H. influenzae, Institute for Hygiene and Microbiology, University of Würzburg
| | - Thiên Trí Lâm
- National Reference Center for Meningococci and H. influenzae, Institute for Hygiene and Microbiology, University of Würzburg
| | - Marc Schneider
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin
| | - Ines Noll
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin
| | - Sebastian Haller
- Joint last authors
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin
| | - Anja von Laer
- Joint last authors
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin
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5
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Vecilla DF, Grande JR, Valcárcel NF, Toboso MCN, Gutiérrez MJU, Muro FEC, Ocampo-Sosa A, Díaz de Tuesta Del Arco JL. Two episodes of bacteremia of zoonotic origin caused by different Streptococcus canis isolates in the same patient within a time span of 1 year. Eur J Clin Microbiol Infect Dis 2024; 43:383-387. [PMID: 37996728 DOI: 10.1007/s10096-023-04718-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023]
Abstract
Two episodes of bacteremia of cutaneous origin in a female patient were caused by two unrelated Streptococcus canis isolates within 1-year interval between the two infection episodes. The most likelihood transmission route in both episodes was a dog pet that habitually licked patient´s legs. Isolates were characterised by antimicrobial susceptibility test and whole genome sequencing. They belonged to sequence type (ST) 40 and 43, respectively. The ST40 isolate harboured antimicrobial resistance genes aadE, ermB and tetO, displaying resistance to erythromycin, clindamycin and tetracyclines, while ST43 isolate did not presented any known antimicrobial resistance determinant and was susceptible to all antibiotics tested. S. canis infections are rare in human; however, attention is needed for patients at risk with companion animals.
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Affiliation(s)
- Domingo Fernández Vecilla
- Clinical Microbiology and Parasitology Department, Basurto University Hospital, Avenida Montevideo 18, 48013, Bilbao, Vizcaya, Spain
- Biocruces Bizkaia Health Research Institute, Cruces Plaza, 48903, Barakaldo, Vizcaya, Spain
| | - Jorge Rodríguez Grande
- Microbiology Service, University Hospital Marqués de Valdecilla, Health Research Institute Marqués de Valdecilla (IDIVAL), Av. Valdecilla S/N, 39008, Santander, Cantabria, Spain
| | - Nuria Fraile Valcárcel
- Microbiology Service, University Hospital Marqués de Valdecilla, Health Research Institute Marqués de Valdecilla (IDIVAL), Av. Valdecilla S/N, 39008, Santander, Cantabria, Spain
| | - María Carmen Nieto Toboso
- Clinical Microbiology and Parasitology Department, Basurto University Hospital, Avenida Montevideo 18, 48013, Bilbao, Vizcaya, Spain
- Biocruces Bizkaia Health Research Institute, Cruces Plaza, 48903, Barakaldo, Vizcaya, Spain
| | - Mikel Joseba Urrutikoetxea Gutiérrez
- Clinical Microbiology and Parasitology Department, Basurto University Hospital, Avenida Montevideo 18, 48013, Bilbao, Vizcaya, Spain
- Biocruces Bizkaia Health Research Institute, Cruces Plaza, 48903, Barakaldo, Vizcaya, Spain
| | - Felicitas Elena Calvo Muro
- Clinical Microbiology and Parasitology Department, Basurto University Hospital, Avenida Montevideo 18, 48013, Bilbao, Vizcaya, Spain
- Biocruces Bizkaia Health Research Institute, Cruces Plaza, 48903, Barakaldo, Vizcaya, Spain
| | - Alain Ocampo-Sosa
- Microbiology Service, University Hospital Marqués de Valdecilla, Health Research Institute Marqués de Valdecilla (IDIVAL), Av. Valdecilla S/N, 39008, Santander, Cantabria, Spain.
- CIBERINFEC, Health Institute Carlos III, Monforte de Lemos 5, 28029, Madrid, Spain.
| | - José Luis Díaz de Tuesta Del Arco
- Clinical Microbiology and Parasitology Department, Basurto University Hospital, Avenida Montevideo 18, 48013, Bilbao, Vizcaya, Spain
- Biocruces Bizkaia Health Research Institute, Cruces Plaza, 48903, Barakaldo, Vizcaya, Spain
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6
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Parajulee P, Lee JS, Abbas K, Cannon J, Excler JL, Kim JH, Mogasale V. State transitions across the Strep A disease spectrum: scoping review and evidence gaps. BMC Infect Dis 2024; 24:108. [PMID: 38243271 PMCID: PMC10799450 DOI: 10.1186/s12879-023-08888-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 12/11/2023] [Indexed: 01/21/2024] Open
Abstract
The spectrum of diseases caused by Streptococcus pyogenes (Strep A) ranges from superficial to serious life-threatening invasive infections. We conducted a scoping review of published articles between 1980 and 2021 to synthesize evidence of state transitions across the Strep A disease spectrum. We identified 175 articles reporting 262 distinct observations of Strep A disease state transitions. Among the included articles, the transition from an invasive or toxin-mediated disease state to another disease state (i.e., to recurrent ARF, RHD or death) was described 115 times (43.9% of all included transition pairs) while the transition to and from locally invasive category was the lowest (n = 7; 0.02%). Transitions from well to any other state was most frequently reported (49%) whereas a relatively higher number of studies (n = 71) reported transition from invasive disease to death. Transitions from any disease state to locally invasive, Strep A pharyngitis to invasive disease, and chronic kidney disease to death were lacking. Transitions related to severe invasive diseases were more frequently reported than superficial ones. Most evidence originated from high-income countries and there is a critical need for new studies in low- and middle-income countries to infer the state transitions across the Strep A disease spectrum in these high-burden settings.
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Affiliation(s)
| | - Jung-Seok Lee
- International Vaccine Institute, Seoul, Republic of Korea
| | - Kaja Abbas
- London School of Hygiene and Tropical Medicine, London, UK
- School of Tropical Medicine and Global Health, Nagasaki, Japan
| | - Jeffrey Cannon
- Telethon Kids Institute, University of Western Australia, Perth, Australia
- Harvard T.H. Chan School of Public Health, Boston, USA
| | | | - Jerome H Kim
- International Vaccine Institute, Seoul, Republic of Korea
- College of Natural Sciences, Seoul National University, Seoul, Republic of Korea
| | - Vittal Mogasale
- International Vaccine Institute, Seoul, Republic of Korea
- World Health Organization, Geneva, Switzerland
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7
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Zou Z, Obernuefemann CLP, Singh P, Pinkner JS, Xu W, Nye TM, Dodson KW, Almqvist F, Hultgren SJ, Caparon MG. Dihydrothiazolo ring-fused 2-pyridone antimicrobial compounds treat Streptococcus pyogenes skin and soft tissue infection. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.01.02.573960. [PMID: 38260261 PMCID: PMC10802287 DOI: 10.1101/2024.01.02.573960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
We have developed GmPcides from a peptidomimetic dihydrothiazolo ring-fused 2-pyridone scaffold that have antimicrobial activities against a broad-spectrum of Gram-positive pathogens. Here we examine the treatment efficacy of GmPcides using skin and soft tissue infection (SSTI) and biofilm formation models by Streptococcus pyogenes. Screening our compound library for minimal inhibitory (MIC) and minimal bactericidal (MBC) concentrations identified GmPcide PS757 as highly active against S. pyogenes. Treatment of S. pyogenes biofilm with PS757 revealed robust efficacy against all phases of biofilm formation by preventing initial biofilm development, ceasing biofilm maturation and eradicating mature biofilm. In a murine model of S. pyogenes SSTI, subcutaneous delivery of PS757 resulted in reduced levels of tissue damage, decreased bacterial burdens and accelerated rates of wound-healing, which were associated with down-regulation of key virulence factors, including M protein and the SpeB cysteine protease. These data demonstrate that GmPcides show considerable promise for treating S. pyogenes infections.
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Affiliation(s)
- Zongsen Zou
- Department of Molecular Microbiology, Center for Women's Infectious Disease Research, Washington University School of Medicine, St. Louis, Missouri 63110, United States
| | - Chloe L P Obernuefemann
- Department of Molecular Microbiology, Center for Women's Infectious Disease Research, Washington University School of Medicine, St. Louis, Missouri 63110, United States
| | - Pardeep Singh
- Department of Chemistry, Umeå University, SE-90187 Umeå, Sweden
| | - Jerome S Pinkner
- Department of Molecular Microbiology, Center for Women's Infectious Disease Research, Washington University School of Medicine, St. Louis, Missouri 63110, United States
| | - Wei Xu
- Department of Molecular Microbiology, Center for Women's Infectious Disease Research, Washington University School of Medicine, St. Louis, Missouri 63110, United States
| | - Taylor M Nye
- Department of Molecular Microbiology, Center for Women's Infectious Disease Research, Washington University School of Medicine, St. Louis, Missouri 63110, United States
| | - Karen W Dodson
- Department of Molecular Microbiology, Center for Women's Infectious Disease Research, Washington University School of Medicine, St. Louis, Missouri 63110, United States
| | | | - Scott J Hultgren
- Department of Molecular Microbiology, Center for Women's Infectious Disease Research, Washington University School of Medicine, St. Louis, Missouri 63110, United States
| | - Michael G Caparon
- Department of Molecular Microbiology, Center for Women's Infectious Disease Research, Washington University School of Medicine, St. Louis, Missouri 63110, United States
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8
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Kempsell-Smith M, Fitzsimons C. Managing the deteriorating child with suspected group A Streptococcus infection. Nurs Child Young People 2023; 35:35-42. [PMID: 37599641 DOI: 10.7748/ncyp.2023.e1467] [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] [Accepted: 03/20/2023] [Indexed: 08/22/2023]
Abstract
Group A Streptococcus bacteria can cause various pyogenic infections such as tonsillitis, pharyngitis, scarlet fever, impetigo, erysipelas, cellulitis and pneumonia. Most group A Streptococcus infections in children are mild and respond positively to treatment with antibiotics. However, some children develop severe infection accompanied by complications such as sepsis and will require urgent treatment, which may include non-invasive or invasive ventilation and the administration of fluids and vasoactive agents. In some instances, for example if there are no beds available in the paediatric intensive care unit, these interventions may be undertaken in a ward setting. This article gives an overview of group A Streptococcus infection, including two rare but severe complications, streptococcal toxic shock syndrome and necrotising fasciitis. It uses a fictionalised case study to examine the management of the deteriorating child with suspected group A Streptococcus infection, including respiratory support, haemodynamic support and symptom management.
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Affiliation(s)
| | - Claire Fitzsimons
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, England
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9
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Strecker T, Treutlein C, Agaimy A, Wehrfritz A. Streptococcal toxic shock syndrome with associated necrotising fasciitis necessitating amputation of the lower extremity - A case report. SAGE Open Med Case Rep 2023; 11:2050313X231207202. [PMID: 37860283 PMCID: PMC10583506 DOI: 10.1177/2050313x231207202] [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: 06/24/2023] [Accepted: 09/26/2023] [Indexed: 10/21/2023] Open
Abstract
Streptococcal toxic shock syndrome is a severe, invasive and life-threatening infection associated with a high risk of rapid multiorgan failure. It is associated with high morbidity and mortality. Streptococcal toxic shock syndrome is very commonly caused by group A-Streptococcus pyogenes, ß-haemolytic streptococcus, a typical human-specific gram-positive bacterial pathogen. We present here the case report of a 54-year-old man with a rapidly progressive streptococcal toxic shock syndrome due to necrotising fasciitis of the left lower limb and describe the successful treatment through close interdisciplinary care.
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Affiliation(s)
- Thomas Strecker
- Centre of Cardiac Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Germany
- Department of Anaesthesiology, Friedrich-Alexander-University Erlangen-Nuremberg, Germany
| | - Christoph Treutlein
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nuremberg, Germany
| | - Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nuremberg, Germany
| | - Andreas Wehrfritz
- Department of Anaesthesiology, Friedrich-Alexander-University Erlangen-Nuremberg, Germany
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10
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Nookala S, Mukundan S, Grove B, Combs C. Concurrent Brain Subregion Microgliosis in an HLA-II Mouse Model of Group A Streptococcal Skin Infection. Microorganisms 2023; 11:2356. [PMID: 37764200 PMCID: PMC10538044 DOI: 10.3390/microorganisms11092356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/28/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
The broad range of clinical manifestations and life-threatening infections caused by the Gram-positive bacterium, Streptococcus pyogenes or Group A Streptococcus (GAS), remains a significant concern to public health, with a subset of individuals developing neurological complications. Here, we examined the concurrent neuroimmune effects of subcutaneous GAS infections in an HLA-Class II (HLA) transgenic mouse model of subcutaneous GAS infection. To investigate changes in the skin-brain axis, HLA-DQ8 (DQA1*0301/DQB1*0302) mice (DQ8) were randomly divided into three groups: uninfected controls (No Inf), GAS infected and untreated (No Tx), and GAS infected with a resolution by clindamycin (CLN) treatment (CLN Tx) (10 mg/kg/5 days) and were monitored for 16 days post-infection. While the skin GAS burden was significantly reduced by CLN, the cortical and hippocampal GAS burden in the male DQ8 mice was not significantly reduced with CLN. Immunoreactivity to anti-GAS antibody revealed the presence of GAS bacteria in the vicinity of the neuronal nucleus in the neocortex of both No Tx and CLN Tx male DQ8 mice. GAS infection-mediated cortical cytokine changes were modest; however, compared to No Inf or No Tx groups, a significant increase in IL-2, IL-13, IL-22, and IL-10 levels was observed in CLN Tx females despite the lack of GAS burden. Western blot analysis of cortical and hippocampal homogenates showed significantly higher ionized calcium-binding adaptor-1 (Iba-1, microglia marker) protein levels in No Tx females and males and CLN Tx males compared to the No Inf group. Immunohistochemical analysis showed that Iba-1 immunoreactivity in the hippocampal CA3 and CA1 subregions was significantly higher in the CLN Tx males compared to the No Tx group. Our data support the possibility that the subcutaneous GAS infection communicates to the brain and is characterized by intraneuronal GAS sequestration, brain cytokine changes, Iba-1 protein levels, and concurrent CA3 and CA1 subregion-specific microgliosis, even without bacteremia.
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Affiliation(s)
- Suba Nookala
- Department of Biomedical Sciences, School of Medicine and Health Sciences, University of North Dakota, Grand Forks, ND 58202, USA; (S.M.); (B.G.); (C.C.)
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11
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Alotaibi NM, Alroqi S, Alharbi A, Almutiri B, Alshehry M, Almutairi R, Alotaibi N, Althoubiti A, Alanezi A, Alatawi N, Almutairi H, Alhmadi M, Almutairi R, Alshammari M. Clinical Characteristics and Treatment Strategies for Group B Streptococcus (GBS) Infection in Pediatrics: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1279. [PMID: 37512090 PMCID: PMC10383037 DOI: 10.3390/medicina59071279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023]
Abstract
Background and Objectives: Group B streptococcus (GBS) is the leading cause of infections in neonates with high fatality rates. GBS is caused by the streptococcus bacterium known as streptococcus agalactiae, which is highly contagious and can be transmitted from pregnant women to infants. GBS infection can occur as an early onset or late-onset infection and has different treatment strategies. Antibiotics are effective in treating GBS infections at early stages. The aim of this systematic review was to summarize the clinical characteristics and treatment strategies for GBS, with a focus on antibiotics. Material and Methods: The findings of this review were reported in accordance with the PRISMA 2020 guidelines and a flow diagram of the study selection process, a summary of the included studies, a description of the study characteristics, a summary of the results, a discussion of the implications of the findings, and a conclusion are included. Overall, the authors followed a rigorous methodology to ensure that this review is comprehensive and inclusive of relevant studies on GBS infection and its treatment. Results: Overall, 940 studies were reviewed and only the most relevant 22 studies were included in the systematic review. This review describes the characteristics of patients in different studies related to early onset GBS disease and presents various treatment strategies and outcomes for GBS infection in pediatrics. The studies suggest that preventive measures, risk-based intrapartum antibiotic prophylaxis, and maternal vaccination can significantly reduce the burden of GBS disease, but late-onset GBS disease remains a concern, and more strategies are required to decrease its rate. Improvement is needed in the management of the risk factors of GBS. A conjugate vaccine with a serotype (Ia, Ib, II, III, and V) has been proven effective in the prevention of GBS in neonates. Moreover, penicillin is an important core antibiotic for treating early onset GBS (EOD). Conclusions: This systematic review summarizes the treatment comparison for GBS infections in neonates, with a primary focus on antibiotics. IAP (intrapartum antibiotic prophylaxis) according to guidelines, antenatal screening, and the development of a conjugate vaccine may be effective and could lower the incidence of the disease.
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Affiliation(s)
- Nawaf M Alotaibi
- Department of Clinical Pharmacy, Northern Border University, Rafhaa 73213, Saudi Arabia
| | - Sharefa Alroqi
- Department of Clinical Pharmacy, Shaqra University, Al-Dawadimi 17472, Saudi Arabia
| | - Abdulrahman Alharbi
- Department of Pharmaceutical Care, King Faisal Specialist Hospital & Research Centre, Al Madinah Al Munawwarah 42355, Saudi Arabia
| | | | - Manal Alshehry
- Department of Clinical Pharmacy, King Khalid Hospital in IV & Nutrition TPN, Tabuk 32593, Saudi Arabia
| | - Rinad Almutairi
- Department of Clinical Pharmacy, Shaqra University, Al-Dawadimi 17472, Saudi Arabia
| | - Nada Alotaibi
- Department of Clinical Pharmacy, Shaqra University, Al-Dawadimi 17472, Saudi Arabia
| | - Atheer Althoubiti
- Hokmaa Taif Medical Complex, Kingdom of Saudi Arabia, Taif 21944, Saudi Arabia
| | - Ashwaq Alanezi
- College of Clinical Pharmacy, King Faisal University, Al-Ahasa 13890, Saudi Arabia
| | - Nouf Alatawi
- Faculty of Pharmacy, University of Tabuk, Tabuk 71491, Saudi Arabia
| | - Hanan Almutairi
- Faculty of Pharmacy, University of Tabuk, Tabuk 71491, Saudi Arabia
| | - Munira Alhmadi
- Department of Clinical Pharmacy, Shaqra University, Al-Dawadimi 17472, Saudi Arabia
| | - Rawan Almutairi
- Department of Clinical Pharmacy, Shaqra University, Al-Dawadimi 17472, Saudi Arabia
| | - Mohammed Alshammari
- Department of Pharmaceutical Care, Northern Border Cluster, Arar 73311, Saudi Arabia
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Sakoulas G, Nowak M, Geriak M. Omadacycline in treating community-based infections: a review and expert perspective. Expert Rev Anti Infect Ther 2023; 21:255-265. [PMID: 36718489 DOI: 10.1080/14787210.2023.2174100] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Omadacycline is approved for the treatment of community-acquired bacterial pneumonia (CABP) and acute bacterial skin and soft tissue infection (ABSSSI). The integration of newer agents into clinical use involves understanding the nuances of clinical decision-making. This review will provide an in-depth focus on omadacycline in clinical practice. AREAS COVERED Literature review of omadacycline utilizing PubMed was performed to provide a comprehensive evaluation of omadacycline pharmacology, microbiology, registrational Phase 3 clinical trials, and post-marketing clinical studies. In addition, the immunomodulatory and other attributes of tetracycline class of antibiotics, of which omadacycline is a member, are reviewed, introducing the concept of antibiotic selection with attention to the bacterial pathogen and human host relationship. EXPERT OPINION Omadacycline builds upon the favorable attributes of tetracycline antibiotics and provides very reliable empiric coverage for both Staphylococcus aureus and Streptococcus spp. Clinicians require a more robust understanding of antibiotics, including omadacycline, in order to optimize patient outcomes, streamline care, and reduce medical costs.
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Affiliation(s)
- George Sakoulas
- Division of Host-Microbe Systems & Therapeutics, Center for Immunity, Infection & Inflammation, University of California-San Diego School of Medicine, La Jolla, CA, USA.,Sharp Rees-Stealy Medical Group and Sharp Memorial Hospital, San Diego, CA, USA.,Sharp Memorial Hospital, San Diego, CA, USA
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13
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Mohapatra RK, Kutikuppala LVS, Mishra S, Tuglo LS, Dhama K. Rising global incidence of invasive group A streptococcus infection and scarlet fever in the COVID-19 era - our knowledge thus far. Int J Surg 2023; 109:639-640. [PMID: 37093100 PMCID: PMC10389320 DOI: 10.1097/js9.0000000000000232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 01/08/2023] [Indexed: 04/25/2023]
Affiliation(s)
- Ranjan K Mohapatra
- Department of Chemistry, Government College of Engineering, Keonjhar, Odisha, India
| | - Lakshmi V S Kutikuppala
- Department of General Surgery, Dr NTR University of Health Sciences, Vijayawada, Andhra Pradesh, India
| | - Snehasish Mishra
- School of Biotechnology, Campus-11, KIIT Deemed University, Bhubaneswar, Odisha, India
| | - Lawrence S Tuglo
- Department of Nutrition and Dietetics, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Bareilly, Uttar Pradesh, India
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Nguyen ADK, Smith S, Davis TJ, Yarwood T, Hanson J. The efficacy and safety of a shortened duration of antimicrobial therapy for group A Streptococcus bacteremia. Int J Infect Dis 2023; 128:11-19. [PMID: 36529371 DOI: 10.1016/j.ijid.2022.12.015] [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: 09/11/2022] [Revised: 11/07/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To determine if shorter courses of antibiotic therapy for group A Streptococcus (GAS) bacteremia are associated with excess mortality. METHODS In this retrospective study of consecutive cases of GAS bacteremia in tropical Australia, the duration of antibiotic therapy was correlated with 90-day all-cause mortality. RESULTS There were 286 episodes of GAS bacteremia; the patients' median (interquartile range) age was 60 (48-71) years and 169/286 (59.1%) patients identified as an Indigenous Australian. There were 227/286 (79.4%) patients with a significant comorbidity. The all-cause 90-day mortality was 16/286 (5.6%); however, 12/16 (81.3%) patients died while still receiving their initial course of antibiotics and only 7/16 (43.8%) deaths were directly attributable to the GAS infection. After excluding patients who died while taking their initial course of antibiotics and those in whom the duration of therapy was uncertain, there was no difference in 90-day mortality between patients receiving ≤5 days of intravenous antibiotics and those receiving longer courses (1/137 [0.7%] vs 3/107 [2.8%], P-value = 0.32) nor in patients receiving ≤10 days of total therapy and those receiving longer courses (1/67 [1.5%] vs 3/178 [1.7%], P-value = 1.0). CONCLUSION Even among patients with significant comorbidity, shorter antibiotic courses for GAS bacteremia are not associated with excess mortality.
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Affiliation(s)
- Andrew D K Nguyen
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Simon Smith
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Tania J Davis
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia
| | - Trent Yarwood
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Josh Hanson
- Department of Medicine, Cairns Hospital, Cairns, Queensland, Australia; The Kirby Institute, University of New South Wales, Sydney, Australia.
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He W, Wu C, Zhong Y, Li J, Wang G, Yu B, Xu P, Xiao Y, Tang T. Case Report: Therapeutic Strategy With Delayed Debridement for Culture-Negative Invasive Group A Streptococcal Infections Diagnosed by Metagenomic Next-Generation Sequencing. Front Public Health 2022; 10:899077. [PMID: 35646803 PMCID: PMC9130855 DOI: 10.3389/fpubh.2022.899077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Streptococcal toxic shock syndrome (STSS) caused by group A streptococcus is a rare condition that rapidly developed to multiple organ failure even death. Therefore, prompt diagnosis, initiate appropriate antibiotics and other supportive treatments are critical. Here we reported a case of STSS caused by group A streptococcus infection. A healthy 39-year-old man presented a sudden pain in the left lower extremity, followed by a high fever (40.0 °C) with dizziness, nausea, and shortness of breath. Twenty-four hours before the visit, the patient showed anuria. The patient was then admitted to the intensive care unit. Blood examination revealed elevated levels of inflammatory markers and creatinine. He suffered from septic shock, dysfunction of coagulation, acute kidney dysfunction, acute respiratory distress syndrome, and acute liver function injury. The diagnosis was obtained through clinical manifestation and metagenomic next-generation sequencing (mNGS) drawn from the pustule and deep soft tissue (lower limb) samples while all bacterial cultures came back negative. The pustule mNGS report detected a total of 132 unique group A streptococcus sequence reads, representing 96.3% of microbial reads while the soft tissue mNGS report identified a total of 142474 unique group A streptococcus sequence reads, representing 100% of microbial reads. The patient was treated with aggressive fluid resuscitation, antibiotics comprising piperacillin/tazobactam and clindamycin, respiratory support, following the delayed surgical debridement. Intravenous immunoglobulin was also used for 5 days. On the 14th day after admission, he was transferred to the general ward for follow-up treatment. Our case highlighted, for the first time, the key role of mNGS in the early diagnosis of culture-negative invasive group A streptococcal infection. The case also suggested that clindamycin combined with beta-lactam antibiotics and adjunction of intravenous immunoglobulin therapy with delayed debridement performed well in the management of unstable STSS patients.
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Affiliation(s)
- Wenfang He
- Department of Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chenfang Wu
- Department of Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yanjun Zhong
- Department of Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Jinxiu Li
- Department of Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Guyi Wang
- Department of Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Bo Yu
- Department of Critical Care Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ping Xu
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
- Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Yiwen Xiao
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
- Institute of Clinical Pharmacy, Central South University, Changsha, China
| | - Tiantian Tang
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, China
- Institute of Clinical Pharmacy, Central South University, Changsha, China
- Hunan Provincial Engineering Research Centre of Translational Medicine and Innovative Drug, Changsha, China
- *Correspondence: Tiantian Tang
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OUP accepted manuscript. J Antimicrob Chemother 2022; 77:1503-1505. [DOI: 10.1093/jac/dkac030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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