Incidence and clinical and microbiological features of invasive and probable invasive streptococcal group A infections in children and adults in the Brussels-Capital Region, 2005–2020

Abstract

Assess the incidence, risk factors, clinical and microbiological features, and outcome of both probable invasive and invasive group A Streptococcus (GAS) infections in children and adults in the BrusselsCapital Region between 2005 and 2020. A retrospective, multicentric study was performed in three university hospitals in Brussels. Patients were identified through the centralized laboratory information system. Epidemiological and clinical data were collected from patients’ hospital records. A total of 467 cases were identified. Incidence has increased from 2.1 to 10.9/100,000 inhabitants between 2009 and 2019 in non-homeless adults while it was above 100/100,000 on homeless in years with available denominators. Most of GAS were isolated from blood (43.6%), and the most common clinical presentation was skin and soft tissue infections (42.8%). A third of all the patients needed surgery, a quarter was admitted to the intensive care unit, and 10% of the adult patients died. Wounds and chickenpox disease were the main risk factors for children. Tobacco, alcohol abuse, wounds or chronic skin lesion, being homeless, and diabetes were identified as major predisposing factors for adults. The most common emm clusters were D4, E4, and AC3; 64% of the isolates were theoretically covered by the 30-valent M-protein vaccine. The burden of invasive and probable invasive GAS infections is on the rise in the studied adult population. We identified potential interventions that could contribute to decrease this burden: appropriate care of wounds, specifically among homeless and patients with risk factors such as diabetes and systematic chickenpox vaccination for children. Supplementary Information The online version contains supplementary material available at 10.1007/s10096-023-04568-y.

Clinical and molecular epidemiological features of critically ill patients with invasive group A Streptococcus infections: a Belgian multicenter case-series

“…Unexpectedly, our critically ill patients had a predominance of pneumonia (56%) as clinical presentation and more than half of patients had toxic shock syndrome, which is different from previous findings of 29–39% pneumonia and 10–16% toxic shock syndrome in iGAS infections in critical care [ 29 , 30 ] and from the Belgian data mentioned earlier (4% pneumonia, 10% toxic shock) [ 7 ]. Despite the fact that pneumonia was not mentioned as a common clinical presentation of iGAS infections in a recent review [ 31 ], and that S. pyogenes was only a rare cause (< 1%) of CAP in the CDC EPIC study 10 years ago [ 32 , 33 ], we believe that intensivists and clinicians today should not discard the possibility of severe S. pyogenes CAP, especially after viral respiratory tract infections in the winter season [ 34 ].…”

“…Moreover, varicella zoster and influenza A viral infections have been associated with iGAS infections [ 2 , 5 , 6 ]. Recent data from the Brussels Capital region (Belgium) showed an increasing incidence of iGAS infections already before the COVID pandemic, from 2.1 to 10.9/100000 inhabitants [ 7 ]. However, this rising trend has not been uniformly observed in other countries [ 8 , 9 ].…”

Streptococcal toxic shock syndrome with associated necrotising fasciitis necessitating amputation of the lower extremity – A case report

“…8 In particular, the combination of a chronic skin lesion in conjunction with long-standing and untreated diabetes mellitus has been identified as an important predisposing factor for invasive Streptococcus pyogenes infection in children and adults. 13 Because STSS can rapidly lead to life-threatening conditions, as mentioned earlier, patients with STSS benefit from very early admission to an appropriate ICU, as was done in this case report. This affects not only adults but also children, and according to preliminary work by Garancini et al, based on data from the WHO, it seems that we are currently facing a new outbreak.…”

Group AStreptococcusstrains causing meningitis without distinct invasive phenotype

“…The most common host-associated risk factors for invasive GAS infections in adults are crowding, diabetes, cardiac disease, cancer and corticosteroid use [12]. Other risk factors are breaching of the physical barriers skin and mucosa by trauma or preceding viral infections such as varicella [13] and influenza [14, 15].…”