Clinical presentation and outcome of bacteraemia caused by beta‐haemolytic streptococci serogroup G

Hindsholm, Marianne; Schønheyder, Henrik Carl

doi:10.1034/j.1600-0463.2002.11007806.x

Cited by 23 publications

(23 citation statements)

References 19 publications

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“…We did not consider the causes of deaths but obtained only the information regarding deaths of the patients from the Central Office of Civil Registration. It has previously been estimated that approximately 90% of deaths within 30 days after cultures were obtained is directly related to the infection (23). The only risk factors significantly associated with 30-day CFR were chronic heart or lung diseases together with increasing age, and patients with skin lesions had a significantly lower fatality rate than patients without skin lesions.…”

Section: Discussionmentioning

confidence: 86%

Reemergence of emm 1 and a Changed Superantigen Profile for Group A Streptococci Causing Invasive Infections: Results from a Nationwide Study

Ekelund¹,

Skinhøj

Madsen

et al. 2005

J Clin Microbiol

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Between 1999 and 2002, 496 invasive group A streptococcal (GAS) isolates from clinical microbiological departments in Denmark and subsequently 487 (98%) questionnaires from the clinicians treating the patients were received as part of a national surveillance. emm types and streptococcal superantigen (SAg) genes were determined. The incidence of invasive GAS infections was on average 2.3 per 100,000 per year. Bacteremia with no focal symptoms (27%) was together with erysipelas (20%) the most prevalent clinical diagnoses. Streptococcal toxic shock syndrome occurred in 10% of patients, of which 56% died. The overall case fatality rate within 30 days was 23%. In total, 47 different emm types were identified, of which emm1, emm3, emm4, emm12, emm28, and emm89 were identified in 72% of the 493 available isolates. During the 4-year period the presence of emm1 increased from 16% in 1999 to 40% in 2002. Concurrently, the presence of emm3 decreased from 23% in 1999 to 2% in 2002. The emm1 isolates predominantly carried speA, although the frequency decreased from 94% in 1999 to 71% in 2002, whereas the emm1-specific prevalence of speC increased from 25 to 53%. In a historical perspective, this could be interpreted as a reemergence of emm1 and could indicate a possible introduction of a new emm1 subclone. However, this reemergence did not result in any significant changes in the clinical manifestations during the study period. Our results show the complexity of invasive GAS infections, with time-dependent variations in the incidence and distribution of emm and SAg genes, which emphasizes the need for continuous epidemiological and molecular investigations.

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Section: Discussionmentioning

confidence: 86%

Reemergence of emm 1 and a Changed Superantigen Profile for Group A Streptococci Causing Invasive Infections: Results from a Nationwide Study

Ekelund¹,

Skinhøj

Madsen

et al. 2005

J Clin Microbiol

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“…The study design did not allow evaluation of whether the cause of the fatal outcome was related to the GAS infection, since the information concerning death was obtained only from the Central Office of Civil Registration. However, it has previously been estimated that approximately 90% of deaths within 30 days after a positive culture result are directly related to the GAS infection (17).…”

Section: Discussionmentioning

confidence: 99%

Variations inemmType among Group A Streptococcal Isolates Causing Invasive or Noninvasive Infections in a Nationwide Study

et al. 2005

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Since the late 1980s several studies have described the increased incidence and severity of invasive group A streptococcal (GAS) infections. However, most studies on GAS pathogenesis have focused on information obtained during outbreaks. We analyzed isolate distribution and host susceptibility as part of a nationwide prospective surveillance study performed between January 2001 and August 2002. GAS isolates collected from 201 patients with invasive infections, 335 patients with noninvasive infections, and 17 asymptomatic carriers were characterized with respect to their emm types and superantigen genotypes. The superantigen-neutralizing capacity and levels of antibodies against streptolysin O and DNAse B were determined for isolates from the sera from 36 invasive cases and 91 noninvasive cases. emm type 1 (emm-1) isolates were significantly more common among invasive cases, whereas emm-4, emm-6, and emm-12 dominated among the noninvasive cases. The distributions of the phage-associated superantigen genes (speA, speC, speH, speI, ssa) differed among invasive and noninvasive isolates, mainly due to their linkage to certain emm types. No significant differences in serum superantigen-neutralizing capacities were observed. The levels of anti-streptolysin O and anti-DNAse B antibodies were highest in the sera from invasive cases. Our study emphasizes the importance of obtaining data during years with stable incidences, which will enable evaluation of future outbreak data.

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“…Due to the extensive overlap of the disease spectrum of GGS with that caused by GAS, it is possible that disease burden specifically attributed to GGS has been historically underestimated. Of late, there are reported increases of GGS infections associated with classic human GAS-associated diseases, including invasive manifestations (10,14,15,19,23,34).…”

Section: Streptococcus Dysgalactiae Subsp Equisimilis Strains (Groupmentioning

confidence: 99%

Phage 3396 from a Streptococcus dysgalactiae subsp. equisimilis Pathovar May Have Its Origins in Streptococcus pyogenes

et al. 2007

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Streptococcus dysgalactiae subsp. equisimilis strains (group G streptococcus [GGS]) are largely defined as commensal organisms, which are closely related to the well-defined human pathogen, the group A streptococcus (GAS). While lateral gene transfers are emerging as a common theme in these species, little is known about the mechanisms and role of these transfers and their effect on the population structure of streptococci in nature. It is now becoming evident that bacteriophages are major contributors to the genotypic diversity of GAS and, consequently, are pivotal to the GAS strain structure. Furthermore, bacteriophages are strongly associated with altering the pathogenic potential of GAS. In contrast, little is know about phages from GGS and their role in the population dynamics of GGS. In this study we report the first complete genome sequence of a GGS phage, ⌽3396. Exhibiting high homology to the GAS phage ⌽315.1, the chimeric nature of ⌽3396 is unraveled to reveal evidence of extensive ongoing genetic diversity and dissemination of streptococcal phages in nature. Furthermore, we expand on our recent findings to identify inducible ⌽3396 homologues in GAS from a region of endemicity for GAS and GGS infection. Together, these findings provide new insights into not only the population structure of GGS but also the overall population structure of the streptococcal genus and the emergence of pathogenic variants.Streptococcus dysgalactiae subsp. equisimilis (group G streptococcus [GGS]) commonly inhabits the throat, skin, and vagina of healthy humans (28). However, occasionally the organism can cause pharyngitis, impetigo, cellulitis, septicemia, glomerulonephritis, and toxic shock (14,28). This same disease spectrum generally coincides with that of a well-known human pathogen, the group A streptococcus (GAS; Streptococcus pyogenes) which cohabits the same tissue sites. Due to the extensive overlap of the disease spectrum of GGS with that caused by GAS, it is possible that disease burden specifically attributed to GGS has been historically underestimated. Of late, there are reported increases of GGS infections associated with classic human GAS-associated diseases, including invasive manifestations (10,14,15,19,23,34).Phylogenetic analyses based on rRNA sequence and other molecular clocks revealed that S. dysgalactiae spp. are closely related to S. pyogenes (16,26,35,38). The observations of overlapping clinical presentations, niche-sharing for colonization, and this evolutionary relatedness are conducive for interspecies lateral genetic transfers (LGT). Previous studies have shown that GGS possesses genes for M protein, C5a peptidase, streptokinase, streptococcal pyrogenic exotoxins, and fibronectin binding proteins (9,20,21,24,25,29,37,40). These are well defined as essential virulence determinants in GAS. The presence of mosaic structures among some of these genes within GAS and GGS strongly suggests that interspecies LGT events do indeed occur between these two streptococci and could be derived from recent and...

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Clinical presentation and outcome of bacteraemia caused by beta‐haemolytic streptococci serogroup G

Cited by 23 publications

References 19 publications

Reemergence of emm 1 and a Changed Superantigen Profile for Group A Streptococci Causing Invasive Infections: Results from a Nationwide Study

Reemergence of emm 1 and a Changed Superantigen Profile for Group A Streptococci Causing Invasive Infections: Results from a Nationwide Study

Variations inemmType among Group A Streptococcal Isolates Causing Invasive or Noninvasive Infections in a Nationwide Study

Phage 3396 from a Streptococcus dysgalactiae subsp. equisimilis Pathovar May Have Its Origins in Streptococcus pyogenes

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