Invasive infections due to Streptococcus pyogenes: seasonal variation of severity and clinical characteristics, Iceland, 1975 to 2012

Ólafsdóttir, Linda Björk; Erlendsdóttir, Helga; Melo‐Cristino, José; Weinberger, Daniel M; Ramírez, Mario; Kristinsson, Karl G.; Gottfreðsson, Magnús

doi:10.2807/1560-7917.es2014.19.17.20784

Cited by 37 publications

(23 citation statements)

References 29 publications

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“…The estimated national incidence is similar to the incidence of invasive GAS in Canada (4.3/100 000) and many European countries (2–4/100 000) (CFR, 14%–19%) [17–21]. However, substantially higher rates of disease have been documented in other geographic areas, including Fiji (9.9/100 000), North Queensland, rural Kenya, and New Zealand (7.9/100 000) [22–25], as well as in European countries experiencing outbreaks, including Iceland (1.1–4.0/100 000), Sweden (6.1/100 000), and Ireland (0.8–2.7/100 000) [26–28]. …”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Invasive Group A Streptococcal Infections in the United States, 2005–2012

et al. 2016

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Background Invasive group A Streptococcus (GAS) infections are associated with significant morbidity and mortality rates. We report the epidemiology and trends of invasive GAS over 8 years of surveillance. Methods From January 2005 through December 2012, we collected data from the Centers for Disease Control and Prevention’s Active Bacterial Core surveillance, a population-based network of 10 geographically diverse US sites (2012 population, 32.8 million). We defined invasive GAS as isolation of GAS from a normally sterile site or from a wound in a patient with necrotizing fasciitis (NF) or streptococcal toxic shock syndrome (STSS). Available isolates were emm typed. We calculated rates and made age- and race-adjusted national projections using census data. Results We identified 9557 cases (3.8 cases per 100 000 persons per year) with 1116 deaths (case-fatality rate, 11.7%). The case-fatality rates for septic shock, STSS, and NF were 45%, 38%, and 29%, respectively. The annual incidence was highest among persons aged ≥65 years (9.4/100 000) or <1 year (5.3) and among blacks (4.7/100 000). National rates remained steady over 8 years of surveillance. Factors independently associated with death included increasing age, residence in a nursing home, recent surgery, septic shock, NF, meningitis, isolated bacteremia, pneumonia, emm type 1 or 3, and underlying chronic illness or immunosuppression. An estimated 10 649–13 434 cases of invasive GAS infections occur in the United States annually, resulting in 1136–1607 deaths. In a 30-valent M-protein vaccine, emm types accounted for 91% of isolates. Conclusions The burden of invasive GAS infection in the United States remains substantial. Vaccines under development could have a considerable public health impact.

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Section: Discussionmentioning

confidence: 99%

Epidemiology of Invasive Group A Streptococcal Infections in the United States, 2005–2012

et al. 2016

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“…The US isolates (1995-2013) were obtained during large epidemiologic studies of invasive infections conducted by the CDC (Active Bacterial Core Surveillance Program; http://www.cdc.gov/ abcs/index.html). The Iceland emm89 isolates were collected during country-wide surveillance studies of invasive infections between 2003 and 2013 (25). The Finnish emm89 GAS strains (all blood isolates) were collected between 2003 and 2013 as part of population-based, national infectious disease surveillance conducted by National Institute for Health and Welfare (THL) (http://www3.thl.fi/stat/).…”

Section: Methodsmentioning

confidence: 99%

A molecular trigger for intercontinental epidemics of group A Streptococcus

Zhu

Olsen²,

Nasser

et al. 2015

Journal of Clinical Investigation

125

225

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R e s e a R c h a R t i c l e 3 5 4 6jci.org Volume 125 Number 9 September 2015 ogous recombinational molecular genetic event resulted in upregulation of production of extracellular NADase and SLO toxins and recently stimulated an epidemic of serotype M89 GAS infections caused by a recently emerged clone. ResultsPre-epidemic and epidemic serotype M1 strains. Mouse invasive infection and nonhuman primate pharyngitis and invasive infection studies show that the MGAS2221 strain, genetically representative of the epidemic ("new") clone, is more virulent than reference strain SF370, genetically representative of pre-epidemic ("old") serotype M1 strains (3). Strain MGAS2221 lacks polymorphisms in regulatory genes known to influence virulence, such as covRS, ropB, and mga. A previous expression microarray analysis of the transcriptomes of pre-epidemic and epidemic M1 strains found that only 8 core chromosomal genes were differentially transcribed between the two strain groups in early logarithmic growth phase (12). Given the clear evidence that pre-epidemic and epidemic M1 strains differ significantly in virulence, we tested the hypothesis that the expression microarray analysis had failed to identify critical virulence genes differentially regulated between the two strain groups. We reassessed global transcriptome differences in a panel of pre-epidemic and epidemic M1 strains using RNA sequencing (RNA-Seq) analysis, a more sensitive and accurate method of transcript analysis. RNA-Seq analysis detected 5 differentially expressed genes, confirming our previous expression microarray findings of very limited gene transcript differences between pre-epidemic and epidemic strains. Of particular interest, all 5 differentially regulated genes were located in the 36-kb region of recombinational replacement. These genes include nga, ifs (encoding Ifs, an endogenous inhibitor of SPN; refs. 15, 16), slo, and two small genes of uncertain function (Spy0142 and Spy0144; SPN enhances GAS survival by inhibiting pathogen internalization by host cells and also augments SLO cytotoxicity (7-10). SLO is a potent oxygen-sensitive cytolytic toxin that forms pores in hostcell membranes (10). The coordinated activities of SPN and SLO prevent maturation of phagolysosomes and thereby decrease phagocytic killing of GAS (9, 11). Several lines of evidence suggest that the nga and slo genes may play a critical role in M1 epidemicity. First, the transcript levels of nga and slo are significantly higher in epidemic strains than in preepidemic M1 GAS strains (12). Second, epidemic M1 strains produce more SPN and SLO activity than pre-epidemic strains (12,13). By comparing the genome sequences of a genetically representative epidemic (MGAS2221) strain and a pre-epidemic (SF370) strain, we discovered that the two strains differ by 59 SNPs and 2 indels in the nga-slo region of recombination (3). Among these SNPs, 3 were of particular interest because they are located in regions that, in principle, might influence nga and slo transcript level and strain phe...

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“…Clindamycin is considered the most effective agent against group A streptococci and is frequently used in the treatment of severe infections such as NF to prevent streptococcal toxic shock syndrome. [7][8][9][10][15][16][17][18][19][20][21][26][27][28][29] Methicillin-resistant S aureus has been talked about since the mid-20th century, when it was first discovered in humans. In the United States, about 3.2% of all ED visits between 2007 and 2010 were related to skin infection, and 68% were treated with anti-MRSA agent antibiotics.…”

Section: Discussionmentioning

confidence: 99%

“…They all have similar initial presentation, and their outcome could vary from antibiotic treatment, surgical debridement, toxic shock, or death. 9,10,[15][16][17][18] Taking into consideration the fast progression of the erythematous reaction, irregular margins, striations, and nonpurulent presentation, the patient was diagnosed with acute cellulitis. The importance of immediate care was explained to the parents, and the patient was referred to the local emergency department (ED).…”

Section: Case Reportmentioning

confidence: 99%

“…These are the conventional guideline medications used for severe skin infections when considering the possibility of NF or MRSA. 10,[15][16][17][18][19][20][21][22][23][24] The rapid spreading of the patient's rash showed pathognomonic markings similar to the presentation of NF, which has a higher potential to induce shock, especially in a young child.…”

Section: Case Reportmentioning

confidence: 99%

See 1 more Smart Citation

Cellulitis of the Knee in a 16-Month-Old Boy: A Case Report

Joubert

Duarte

2016

Journal of Chiropractic Medicine

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Objective: The purpose of this case report is to describe the presentation of cellulitis in a 16-month-old boy to a chiropractic clinic. Clinical Features: The patient presented with nontraumatic, sudden onset of nonpurulent erythema on the right knee. A plain film radiograph of the knee showed a 40-mm thickening of the anterior knee. A diagnosis of cellulitis was rendered based on the presentation of the rapidly spreading erythema and radiographically confirmed findings. Intervention and Outcome: The patient was immediately referred to the local emergency room. The patient was hospitalized, treated with clindamycin and amoxicillin for 3 days, and then discharged. The patient's pediatrician discontinued clindamycin treatment at the posthospitalization follow-up. Two weeks after treatment was discontinued, the patient was diagnosed with recurrent cellulitis. Conclusion: This case demonstrated that for this young patient with cellulitis of the knee, timely recognition and referral, together with patient or parent education and immediate treatment, were essential to a successful outcome.

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Invasive infections due to Streptococcus pyogenes: seasonal variation of severity and clinical characteristics, Iceland, 1975 to 2012

Cited by 37 publications

References 29 publications

Epidemiology of Invasive Group A Streptococcal Infections in the United States, 2005–2012

Epidemiology of Invasive Group A Streptococcal Infections in the United States, 2005–2012

A molecular trigger for intercontinental epidemics of group A Streptococcus

Cellulitis of the Knee in a 16-Month-Old Boy: A Case Report

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