Long-term surveillance of invasive group A streptococcal disease in The Netherlands, 1994–2003

Vlaminckx, Bart J. M.; Pelt, Wilfrid van; Schouls, Leo M.; Silfhout, A. van; Mascini, Ellen M.; Elzenaar, C.P.; Fernandes, Tricia; Bosman, A; Schellekens, J. F. P.

doi:10.1111/j.1469-0691.2004.01068.x

Cited by 32 publications

(33 citation statements)

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“…In the present study, speA was also detected in all isolates of the two major PFGE clusters, but all other isolates lacked speA, and the most frequent exotoxin gene found was speC. The exotoxin gene profile of the main invasive clone in Portugal is in agreement with previous reports for isolates of the same emm type (emm1) in other countries (2,18,23). On the other hand, though ssa has recently been reported as being more prevalent among M1/emm1 invasive isolates than among M1/emm1 noninvasive isolates (4, 17), it was not found among any of the emm1 isolates in this study.…”

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confidence: 81%

Nonoutbreak Surveillance of Group A Streptococci Causing Invasive Disease in Portugal Identified Internationally Disseminated Clones among Members of a Genetically Heterogeneous Population

2007

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The typing of 160 invasive Streptococcus pyogenes isolates confirmed the importance of pulsed-field gel electrophoresis and multilocus sequence typing for defining clones. The results identified an extremely diverse population and highlighted the importance of both internationally disseminated and local clones not previously associated with invasive disease.A reemergence of invasive disease caused by Streptococcus pyogenes (a member of the group A streptococci [GAS]) has been noted since the late 1980s, both in North America and in Europe (3). This increase in the incidence of GAS infections has frequently been associated with specific clones, suggesting the possibility that the rise of particularly virulent clones is responsible for this reemergence. The identification of GAS clones in surveillance and epidemiological studies has frequently relied on serotyping using two variable surface antigens, the T antigen (T typing) and the M protein (M typing, or emm typing, as the protein is encoded by the emm gene) (3). Recent work suggests that emm typing alone is not sufficient to unambiguously identify GAS clones and that this method must be complemented with an analysis by either pulsed-field gel electrophoresis (PFGE) or multilocus sequence typing (MLST) (1). A total of 160 nonduplicate GAS isolates recovered from normally sterile sites (150 from blood, 7 from pleural fluid, and 3 from cerebrospinal fluid) were collected in 19 laboratories distributed throughout Portugal that were asked to submit all isolates between 2000 and 2005. The number of participating laboratories was not constant, and this variation was reflected in the number of isolates available in each of the study years Twelve different T serotypes (20) were identified, and 23 isolates (14%) were nontypeable (Simpson's index of diversity [SID] Ϯ 95% confidence interval [CI], 88.2% Ϯ 2.3%) (1), whereas 30 different emm types were identified (SID Ϯ 95% CI, 92.0% Ϯ 2.0%). The presence of genes encoding GAS pyrogenic toxins was studied by PCR (2, 9, 16, 18). As expected, the results confirmed the presence of the chromosomal genes speB and speF in all strains except one. Eleven different exotoxin gene profiles were identified (SID Ϯ 95% CI, 82.2% Ϯ 3.0%), but a significant fraction of the isolates (16%) were negative for all but the chromosomal genes ( Table 1).The dendrogram based on the PFGE profiles of SmaI-or Cfr9I-digested total DNA (1, 19) from the isolates identified 13 major clusters accounting for 86% of all isolates (SID Ϯ 95% CI, 92.0% Ϯ 2.1%) (Fig. 1). Among the 37 isolates characterized by MLST (5), four new alleles were identified and submitted to the S. pyogenes MLST database, namely, recP82, gki98, gtr73, and murI68, as well as seven new sequence types (STs; ST258 and ST406 to ST411) that are all single-locus variants of preexisting STs, except for ST258, which is a double-locus variant of three preexisting STs. The overall level of correspondence between PFGE clusters and emm types was high, with a Wallace coefficient of 0.890, meaning th...

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confidence: 81%

Nonoutbreak Surveillance of Group A Streptococci Causing Invasive Disease in Portugal Identified Internationally Disseminated Clones among Members of a Genetically Heterogeneous Population

2007

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“…With the reemergence of invasive GAS disease in the 1980s, there have been numerous reports published describing the burden of GAS disease in industrialized countries (7,9,13,(17)(18)(19)(20)36). In these reports, invasive GAS disease rates ranged from 1.5 to 5.8 cases/100,000 persons.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Invasive Group A Streptococcal Disease in Alaska, 2001 to 2013

et al. 2016

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The Arctic Investigations Program (AIP) began surveillance for invasive group A streptococcal (GAS) infections in Alaska in 2000 as part of the invasive bacterial diseases population-based laboratory surveillance program. Between 2001 and 2013, there were 516 cases of GAS infection reported, for an overall annual incidence of 5.8 cases per 100,000 persons with 56 deaths (case fatality rate, 10.7%). Of the 516 confirmed cases of invasive GAS infection, 422 (82%) had isolates available for laboratory analysis. All isolates were susceptible to penicillin, cefotaxime, and levofloxacin. Resistance to tetracycline, erythromycin, and clindamycin was seen in 11% (n ‫؍‬ 8), 5.8% (n ‫؍‬ 20), and 1.2% (n ‫؍‬ 4) of the isolates, respectively. A total of 51 emm types were identified, of which emm1 (11.1%) was the most prevalent, followed by emm82 (8.8%), emm49 (7.8%), emm12 and emm3 (6.6% each), emm89 (6.2%), emm108 (5.5%), emm28 (4.7%), emm92 (4%), and emm41 (3.8%). The five most common emm types accounted for 41% of isolates. The emm types in the proposed 26-valent and 30-valent vaccines accounted for 56% and 78% of all cases, respectively. GAS remains an important cause of invasive bacterial disease in Alaska. Continued surveillance of GAS infections will help improve understanding of the epidemiology of invasive disease, with an impact on disease control, notification of outbreaks, and vaccine development.

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“…The mean incidence during the study period was 2.6 cases per 100,000 inhabitants, which was similar to that during the last two decades in Denmark (16) and to other reported Scandinavian data (10,16,19,54). Population-based surveillance studies from the United States, Canada, and The Netherlands have shown rates ranging between 1.5 and 5 cases per 100,000 inhabitants per year (30,36,37,56). A seasonal fluctuation could be observed, with an elevated number of cases during January to April, which could be explained by the well-known influence of indoor overcrowding on transmission of streptococci (46).…”

Section: Discussionmentioning

confidence: 99%

Clinical and Epidemiological Aspects of Invasive Streptococcus pyogenes Infections in Denmark during 2003 and 2004

et al. 2008

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Active surveillance of invasive group A streptococcal (GAS) infections was conducted in Denmark during2003 and 2004 as a part of the Strep-EURO initiative. The main objective was to improve understanding of the epidemiology of invasive GAS disease in Denmark. During the 2 years, 278 cases were reported, corresponding to a mean annual incidence of 2.6 cases per 100,000 inhabitants. The vast majority of isolates, 253 (91%), were from blood, with the remaining 25 (9%) being from cerebrospinal fluid, joints, or other normally sterile sites. The mean case fatality rate (CFR) was 20%, with the rate being higher in patients more than 70 years of age (36.5%). For streptococcal toxic shock syndrome (STSS) and necrotizing fasciitis the CFRs were 53% and 25%, respectively. Out of 16 T types recorded, three predominated: T28 (23%), T1 (22%), and the cluster T3/13/B3264 (14%). Among 29 different emm types, emm28 and emm1 accounted for 51% of strains, followed by emm3 (11%), emm89 (7%), and emm12 (5.5%). Low resistance rates were detected for macrolide-lincosamide-streptogramin B (MLS B ) antibiotics (3%) and tetracycline (8%); two isolates exhibited coresistance to tetracycline and macrolides. Of nine pyrogenic exotoxin (superantigen) genes examined, speA and speC were identified in 58% and 40% of the strains, respectively; either of the genes was present in all strains causing STSS. Most strains harbored speG (99%). ssa was present in 14% of the isolates only. In Denmark, as in comparable countries, GAS invasive disease shows a sustained, high endemicity, with involvement of both established and emerging streptococcal emm and T types.

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Long-term surveillance of invasive group A streptococcal disease in The Netherlands, 1994–2003

Cited by 32 publications

References 42 publications

Nonoutbreak Surveillance of Group A Streptococci Causing Invasive Disease in Portugal Identified Internationally Disseminated Clones among Members of a Genetically Heterogeneous Population

Nonoutbreak Surveillance of Group A Streptococci Causing Invasive Disease in Portugal Identified Internationally Disseminated Clones among Members of a Genetically Heterogeneous Population

Epidemiology of Invasive Group A Streptococcal Disease in Alaska, 2001 to 2013

Clinical and Epidemiological Aspects of Invasive Streptococcus pyogenes Infections in Denmark during 2003 and 2004

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