Invasive group A, B, C and G streptococcal infections in Denmark 1999–2002: epidemiological and clinical aspects

Abstract

Group A streptococci (GAS) have been described frequently as an emerging cause of severe invasive infections in population-based surveillance studies, whereas the descriptions of group B, C and G streptococci (GBS, GCS and GGS) have been less frequent. Enhanced surveillance for invasive GAS, GBS, GCS and GGS was performed in Denmark in 1999-2002. A detailed questionnaire was completed for 1237 (98%) of 1260 invasive infections. GAS infections dominated (40%), followed by GGS (32%), GBS (23%) and GCS (6%). Most (74%) patients had predisposing factors, and there were no significant differences between the four serogroups when comparing the prevalence of cancer, diabetes mellitus, chronic heart or lung diseases, immunodeficiency or alcohol abuse. The overall case fatality rate at day 30 was 21%, increasing significantly to 59% for patients with streptococcal toxic shock syndrome (STSS). STSS was significantly more frequent in GAS patients (10%) than in GCS (4%), GBS (2%) and GGS (2%) patients. Regression analyses showed that, despite a younger median age among GAS patients, the probability of developing septic shock and mortality was significantly higher among GAS patients than among GBS and GGS patients. These analyses showed no significant differences between GAS and GCS infections. Invasive infections caused by GAS, GBS, GCS and GGS are still a major challenge for clinicians. Continued epidemiological and microbiological surveillance is important to assess the development of these infections and to improve preventative strategies.

SevereStreptococcus pyogenesInfections, United Kingdom, 2003–2004

“…However, our fi nding was consistent with those in studies in other countries (11,13,17,19,21,22). The case-fatality rate in our study (32% within 7 days of initial diagnosis) was substantially higher than that expected with community-acquired pneumonia (23).…”

“…This fi nding is consistent with previous (unadjusted) fi ndings from the United States (17) but different from fi ndings from Canada, which only identifi ed emm/M9, a strain uncommon in the United Kingdom, as associated with STSS (13). Alcoholism was associated with increased risk for STSS; this association was also found in other studies (13,22). However, risk for STSS was 3-fold greater for patients who were reported to have used nonsteroidal antiinfl ammatory drugs, despite adjustment for whether patients had necrotizing fasciitis, which is strongly associated with STSS.…”

“…Questionnaires concerning possible predisposing factors have highlighted skin lesions as the most commonly identifi ed potential source of infection, which is similar to fi ndings in other countries (18,22). However, given the occult nature of S. pyogenes infections, as indicated by the high proportion (21%) of cases with no identifi ed focus, several of these cases may have originated from respiratory tract colonization.…”

Septic Osteoarthritis Due to Streptococcus dysgalactiae Subspecies equisimilis in a Three-Year-Old Girl

“…Transmission from sites of colonization and infections are the main transmission mechanisms, zoonosis is also being described (17,18). SDSE bacteremia is uncommon in children (19); among adults almost all patients have an underlying disease. Predisposing factors for bacteremia and invasive infection are identified, skin breakdown being the most common of them; age over 65 years, diabetes, cardiovascular disease and malignancy or immunosuppression are also described as predisposing factors.…”

Prevalence of the M Protein Gene in Group C and Group G Streptococci Isolated from Patients in Thailand

“…Increasing numbers of GGS infections have been reported in the USA (3) and Denmark (4). GCS/GGS share virulence factors with group A streptococci (GAS); among the M protein, which is expressed on the outer surfaces of these organisms (1,2) and inhibits phagocytosis (1).…”