Increasing Incidence of Invasive Group A <i>Streptococcus</i> Disease, Idaho, USA, 2008–2019

Dunne, Eileen M.; Hutton, Scott R.; Peterson, Erin E.; Blackstock, Anna J.; Hahn, Christine; Turner, Kathryn; Carter, Kris K.

doi:10.3201/eid2809.212129

Cited by 18 publications

(13 citation statements)

References 31 publications

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“…The respiratory tract and skin are the two main portals of entry for iGAS [ 4 ]. There are well-known risk factors associated with iGAS.…”

Section: Epidemiologymentioning

confidence: 99%

“…In children, the most common emm in Spain type has been emm1 [ 13 , 14 ] in keeping with other European countries [ 14 ]. Although it is possible that changes in GAS genome could have led to increased transmissibility or virulence, there has been diversity of strains, and only a minority of cases are attributed to outbreaks [ 4 ]. By contrast, the recent upsurge in IGAS in children has been linked to marked seasonal peaks in incidence of respiratory viral pathogens (mostly RSV and influenza), after withdrawing the strict preventive measures against COVID-19 [ 7 ].…”

Section: Epidemiologymentioning

confidence: 99%

“…The overall mortality in this study was 1.8% [ 6 ]. Based on published series, the mortality reported ranged from 0-8% [ 2 ], still lower than that observed in adults [ 4 ]. Table 1 shows the main characteristics of the Spanish children included in PedGAS-net [ 6 ]…”

Section: Clinical Manifestations Of Igasmentioning

confidence: 99%

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Group A Streptococcus invasive infection in children: Epidemiologic changes and implications

Ramos Amador,

Berzosa Sánchez,

Illán Ramos

2023

Rev Esp Quimioter

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Group A Streptococcus (GAS) can cause a broad array of clinical manifestations and complications. Recently, in post COVID-19 postpandemic months, there has been an increased incidence and severity of invasive infections in the pediatric age group in Spain and other European countries with high morbidity, affecting mostly to young children, associated with seasonal peaks in incidence of viral respiratory pathogens. The increased in incidence and severity has not been associated with predominant GAS strains, but rather to the lack of immunity to both GAS and common viral respiratory infections due to isolation measures to prevent COVID-19. Due to the nonspecific initial clinical manifestations a high index of suspicion is necessary in order to initiate a prompt medical and surgical treatment when necessary to improve the outcome. Prevention strategies are needed as well as continuous microbiological surveillance of iGAS strains.

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“…The respiratory tract and skin are the two main portals of entry for iGAS [ 4 ]. There are well-known risk factors associated with iGAS.…”

Section: Epidemiologymentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%

See 1 more Smart Citation

Group A Streptococcus invasive infection in children: Epidemiologic changes and implications

Ramos Amador,

Berzosa Sánchez,

Illán Ramos

2023

Rev Esp Quimioter

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“…In recent years, the frequency of STSS has increased, along with the incidence of invasive infections by GAS and other groups of beta-hemolytic streptococci. [ 3 , 26 ] Saving the lives of patients with fatal STSS remains a major concern for health care providers. VA-ECMO for patients with fatal STSS may contribute to an improved prognosis; however, further reporting of cases, database establishment, and validation are needed to prove its efficacy.…”

Section: Discussionmentioning

confidence: 99%

Venoarterial extracorporeal membrane oxygenation for group B streptococcal toxic shock syndrome: A case report and literature review

Iwasaki,

Sekino,

Tominaga

et al. 2023

Medicine

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Rationale: Streptococcal toxic shock syndrome (STSS) rapidly leads to refractory shock and multiple organ failure. The mortality rate among patients with STSS is 40%; however, most deaths occur within a few days of onset. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) may help avoid acute death in adult patients with STSS. However, the effectiveness of VA-ECMO is unclear. In this study, we report a case of group B STSS, which was successfully treated with VA-ECMO despite cardiopulmonary arrest (CPA) owing to rapidly progressive refractory shock. Patient concerns: A 60-year-old woman was hospitalized because of diarrhea and electrolyte abnormalities owing to chemoradiation therapy for rectal cancer. A sudden deterioration of her condition led to CPA. Conventional cardiopulmonary resuscitation was immediately performed but was ineffective. Therefore, VA-ECMO was initiated. Contrast-enhanced computed tomography revealed duodenal perforation. Hence, septic shock owing to peritonitis was diagnosed, and emergency surgery was performed under VA-ECMO. However, the patient had progressive multiple organ failure and required organ support therapy in the intensive care unit (ICU). Diagnoses: On day 2 in the ICU, blood and ascites fluid culture tests revealed beta-hemolytic streptococci, and the patient was finally diagnosed as having STSS caused by Streptococcus agalactiae. Interventions: Clindamycin was added to meropenem, vancomycin, and micafungin, which had been administered since the sudden deterioration. In addition, VA-ECMO, mechanical ventilation, blood purification therapy, and treatment for disseminated intravascular coagulation were continued. Outcomes: Thereafter, hemodynamics improved rapidly, and the patient was weaned off VA-ECMO on day 5 of ICU admission. She was transferred to a general ward on day 22 in the ICU. Lessons: In patients with fatal STSS and rapid progressive refractory shock or CPA, VA-ECMO may help to avoid acute death and improve prognosis by ameliorating tissue oxygenation and providing extra time to treat invasive streptococcal infection.

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“…One such species is GAS, an obligate human pathobiont and the causative agent of a diverse array of infections ranging from pharyngitis and scarlet fever to necrotising fasciitis 1 . Genotype emm1 GAS are responsible for an ongoing and unprecedented global surge in infections, the molecular basis for which remains unknown [2][3][4][5] . The development of an improved transformation protocol for emm1 GAS is thus essential to expedite critical research into the pathophysiology of this genotype.…”

Section: Observationmentioning

confidence: 99%

Methylome-dependent transformation ofemm1 group A streptococci

Alves

Rand

Johnston

et al. 2023

Preprint

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Genetic intractability presents a fundamental barrier to the manipulation of bacteria, hindering advancements in microbiological research. Group AStreptococcus(GAS), a lethal human pathogen currently associated with an unprecedented surge of infections world-wide, exhibits poor genetic tractability attributed to the activity of a conserved type 1 restriction modification system (RMS). RMS detect and cleave specific target sequences in foreign DNA that are protected in host DNA by sequence-specific methylation. Overcoming this “restriction barrier” thus presents a major technical challenge. Here we demonstrate for the first time that different RMS variants expressed by GAS give rise to genotype-specific and methylome-dependent variation in transformation efficiency. Further, we show that the magnitude of impact of methylation on transformation efficiency elicited by RMS variant TRDAG, encoded by all sequenced strains of the dominant and upsurge-associatedemm1 genotype, is 100-fold greater than for all other TRD tested and is responsible for the poor transformation efficiency associated with this lineage. In dissecting the underlying mechanism, we developed an improved GAS transformation protocol whereby the restriction barrier is overcome by addition of the phage anti-restriction protein Ocr. This protocol is highly effective for TRDAGstrains including clinical isolates representing allemm1 lineages, and will expedite critical research interrogating the genetics ofemm1 GAS, negating the need to work in an RMS-negative background. These findings provide a striking example of the impact of RMS target sequence variation on bacterial transformation, and the importance of defining lineage-specific mechanisms of genetic recalcitrance.

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Increasing Incidence of Invasive Group A Streptococcus Disease, Idaho, USA, 2008–2019

Cited by 18 publications

References 31 publications

Group A Streptococcus invasive infection in children: Epidemiologic changes and implications

Group A Streptococcus invasive infection in children: Epidemiologic changes and implications

Venoarterial extracorporeal membrane oxygenation for group B streptococcal toxic shock syndrome: A case report and literature review

Methylome-dependent transformation ofemm1 group A streptococci

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