Invasive Group A Streptococcal Disease: Risk Factors for Adults

Factor, Stephanie H.; Levine, Orin S.; Schwartz, Benjamin; Harrison, Lee H.; Farley, Monica M.; McGeer, Allison; Schuchat, Anne

doi:10.3201/eid0908.020745

Cited by 128 publications

(89 citation statements)

References 19 publications

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“…Rather, what is seen is elevated numbers of M types present the year before at lower rates, e.g., M3 at 7.4% (2000) Also of note is the high rate of NF seen during the 3-year period. The rate of 12% is double that reported by both Davies et al for Ontario (6) and by Factor et al for metropolitan Atlanta, Baltimore, and Toronto in 1997 (6%) (9). The reason for the higher rate of NF in Alberta than elsewhere in North America is uncertain.…”

Section: Discussionsupporting

confidence: 43%

Invasive Group A Streptococcal Disease in Alberta, Canada (2000 to 2002)

et al. 2005

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Invasive group A streptococcal (iGAS) disease was placed under surveillance in Alberta in August 1999. The purpose of this study was to determine the incidence rates of iGAS infections throughout Alberta over a 3-year period (2000 to 2002) and to better understand the epidemiology of iGAS in this province. There were a total of 441 cases of invasive GAS disease over the 3 years examined (average population over 3

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Section: Discussionsupporting

confidence: 43%

Invasive Group A Streptococcal Disease in Alberta, Canada (2000 to 2002)

et al. 2005

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“…An SSTI was defined as an infection that was associated with inflammation of the skin or soft tissue but that excluded cervical adenitis, pharyngeal infection, and cutaneous inflammation overlying septic arthritis (27). An invasive SSTI was defined as an infection meeting the criteria of SSTI, with the addition of isolation of GAS from a normally sterile body site, such as blood samples, surgical specimens, intraoperative swabs, or aspirates of soft tissue or abscesses (14,27). A noninvasive SSTI was defined as an infection meeting the criteria of SSTIs, with the addition of the isolation of GAS from a nonsterile site, such as a superficial wound, impetigo, or pyoderma (30).…”

Section: Methodsmentioning

confidence: 99%

Clinical and Molecular Characteristics of Invasive and Noninvasive Skin and Soft Tissue Infections Caused by Group A Streptococcus

et al. 2011

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The severity of skin and soft tissue infections caused by group A Streptococcus (GAS) is variable, and there are only a limited number of studies evaluating the characteristics of these infections in the literature. From May 2005 to November 2007, 73 patients with skin and soft tissue infections caused by group A Streptococcus were included in this study. Among these patients, 34 (46.6%) had invasive diseases. Diabetes mellitus, alcoholism, and hypertension were the most common underlying disorders. The overall mortality rate was 6.8%, and the elderly were predisposed to invasive infections (P < 0.001). Neutrophil percentages of >80, serum creatinine levels of >2 mg/dl, and high serum C-reactive protein levels were noted more frequently in patients with invasive infections than in patients with noninvasive infections, as were bacteremia and a high mortality rate. Of the 73 isolates, 93.2%, 97.3%, and 37% exhibited susceptibility to erythromycin, clindamycin, and tetracycline, respectively. The five most prevalent emm types were emm106 (24.7%), emm11 (12.3%), emm102 (9.6%), emm4 (8.2%), and emm12 (8.2%). Compared to other types, the emm106 type was significantly more likely to be associated with invasive diseases (P ‫؍‬ 0.012). Dendrogram analysis showed a unique SmaI-digested pulsed-field gel electrophoresis pattern of the emm106 type that was particularly prone to cause invasive skin and soft tissue infections (P < 0.001). The results of this study suggest that isolates with the emm106 gene may be an emerging group A Streptococcus strain that causes invasive skin and soft tissue infections. Further surveillance study to understand the significance of this invasive strain is critical.Group A Streptococcus (GAS), also known as Streptococcus pyogenes, is a Gram-positive coccus that is arranged in pairs and chains. These organisms are ubiquitous in the environment and are responsible for a broad spectrum of human infections that result in significant morbidity and mortality, including pharyngitis, scarlet fever, skin and soft tissue infection (SSTI), streptococcal toxic shock syndrome, septicemia, pneumonia, and meningitis (10). It is estimated that severe GAS diseases lead to more than 500,000 deaths each year via infections such as acute rheumatic fever, rheumatic heart disease, poststreptococcal glomerulonephritis, and invasive diseases (6).SSTIs are common and account for approximately 7 to 10% of hospitalizations in North America (12, 13). The manifestations of SSTIs caused by GAS range from mild superficial impetigo, erysipelas, pyoderma, and cellulitis to life-threatening necrotizing fasciitis or myonecrosis. The early discrimination between noninvasive SSTIs that can be resolved with antimicrobial treatment and invasive infections that may additionally require surgical intervention is critical. Unfortunately, the clinical symptoms and signs of invasive SSTIs, including disproportionate pain, bullae, ecchymosis, sloughing, skin anesthesia, rapid progression, gas in the tissue, and systemic toxicity, often ap...

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“…Among host factors, age; underlying disease, such as diabetes, varicella, or other acute or chronic skin lesions; or specific risk behaviors, such as injecting drug use, are known to influence the risk of S. pyogenes infection (7,12,13,34). Environmental factors, such as household size and overcrowding (33), are also known to play an important role in influencing S. pyogenes transmission.…”

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confidence: 99%

Epidemiology of Severe Streptococcus pyogenes Disease in Europe

Lamagni¹,

et al. 2008

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The past 2 decades have brought worrying increases in severe Streptococcus pyogenes diseases globally. To investigate and compare the epidemiological patterns of these diseases within Europe, data were collected through a European Union FP-5-funded program (Strep-EURO). Prospective population-based surveillance of severe S. pyogenes infection diagnosed during 2003 and 2004 was undertaken in 11 countries across Europe (Cyprus, the Czech Republic, Denmark, Finland, France, Germany, Greece, Italy, Romania, Sweden, and the United Kingdom) using a standardized case definition. A total of 5,522 cases were identified across the 11 countries during this period. Rates of reported infection varied, reaching 3/100,000 population in the northern European countries. Seasonal patterns of infection showed remarkable congruence between countries. The risk of infection was highest among the elderly, and rates were higher in males than in females in most countries. Skin lesions/wounds were the most common predisposing factor, reported in 25% of cases; 21% had no predisposing factors reported. Skin and soft tissue were the most common foci of infection, with 32% of patients having cellulitis and 8% necrotizing fasciitis. The overall 7-day case fatality rate was 19%; it was 44% among patients who developed streptococcal toxic shock syndrome. The findings from Strep-EURO confirm a high incidence of severe S. pyogenes disease in Europe. Furthermore, these results have identified targets for public health intervention, as well as raising awareness of severe S. pyogenes disease across Europe.

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Invasive Group A Streptococcal Disease: Risk Factors for Adults

Cited by 128 publications

References 19 publications

Invasive Group A Streptococcal Disease in Alberta, Canada (2000 to 2002)

Invasive Group A Streptococcal Disease in Alberta, Canada (2000 to 2002)

Clinical and Molecular Characteristics of Invasive and Noninvasive Skin and Soft Tissue Infections Caused by Group A Streptococcus

Epidemiology of Severe Streptococcus pyogenes Disease in Europe

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