Familial Transmission of a Serious Disease–Producing Group A Streptococcus Clone: Case Reports and Review

Abstract

Invasive group A streptococcus (GAS) infections are emerging diseases; however, person-to-person transmission of invasive GAS producing life-threatening infection has been observed rarely. We report a small intrafamilial cluster of life-threatening GAS infections. A previously healthy 47-year-old father developed necrotizing fasciitis of the neck. Two days later, his 16-year-old daughter developed streptococcal angina, pneumonia, and pleural empyema. Both patients had signs of streptococcal toxic shock syndrome. Pulsed field gel electrophoresis revealed that the M6 strains of GAS isolated from the father and daughter had identical patterns. Cases of person-to-person transmission of invasive GAS infection reported in the literature are also reviewed.

Group A streptococcal sepsis

“…Similarly, from November to December 2002, there was an epidemic of invasive GAS infections among Marine Corp recruits at the San Diego Naval Training Base [4]. In addition to community-based infections, invasive GAS infections have been described in hospitals, convalescent centers, and among hospital employees and family contacts of patients with invasive infections [5][6][7]. Some of these studies have documented the same M type and identical restriction fragment length polymorphism patterns in strains from primary and index cases [5][6][7][8].…”

“…Although most invasive GAS infections in institutions have been single and isolated cases, outbreaks have occurred [9][10][11][12]. In some epidemics, carriage of GAS by health care personnel has been associated with the spread of life-threatening GAS infections among patients in obstetrics/ gynecology and ear-nose-throat wards of US hospitals [13].…”

Invasive streptococcal infections

“…In addition to community-based infections, invasive group A streptococcal infections have also been described in hospitals, convalescent centers, and among hospital employees and family contacts of patients with invasive infections. 9,45,46 Some of these studies have documented the same M-type and identical RFLP patterns in strains from primary and index cases. 9,[45][46][47] In addition, carriage of group A streptococcus by healthcare personnel has been associated with the spread of life-threatening group A streptococcal infections in the obstetrics/gynecology and ear-nose-throat wards of American hospitals.…”

“…16 Most cases of StrepTSS occur sporadically, although outbreaks of severe group A streptococcal infections have been described in closed environments, such as nursing homes, 49,50 and hospital environments. 45,46 Symptoms and signs Twenty percent of patients have an influenza-like syndrome, characterized by fever, chills, myalgia, nausea, vomiting, and diarrhea. 16 Fever is the most common presenting sign, although hypothermia may be present in patients with shock.…”

Necrotizing soft tissue infections

“…Secondary cases are rare but have been reported among family members and with intimate contact and among medical personnel caring for patients [26,27].…”