scholarly journals Rapid Emergence of a New Clone Impacts the Population at Risk and Increases the Incidence of Type emm89 Group A Streptococcus Invasive Disease

2017 ◽  
Vol 4 (2) ◽  
Author(s):  
Sarah Teatero ◽  
Brenda L. Coleman ◽  
Stephen B. Beres ◽  
Randall J. Olsen ◽  
Christopher Kandel ◽  
...  
Keyword(s):  
Group A Streptococcus ◽  
Invasive Disease ◽  
Population Based ◽  
Invasive Group ◽  
Clonal Variant ◽  
Clinical Presentations ◽  
Group A ◽  
Tract Infections ◽  
Rapid Shift ◽  
Rapid Emergence

Abstract Background Invasive group A Streptococcus (iGAS) disease caused by type emm89 strains has been increasing worldwide, driven by the emergence of an epidemic clonal variant (clade 3 emm89). The clinical characteristics of patients with emm89 iGAS disease, and in particular with clade 3 emm89 iGAS disease, are poorly described. Methods We used population-based iGAS surveillance data collected in metropolitan Toronto, Ontario, Canada during the period 2000–2014. We sequenced the genomes of 105 emm89 isolates representing all emm89 iGAS disease cases in the area during the period and 138 temporally matched emm89 iGAS isolates collected elsewhere in Ontario. Results Clades 1 and 2 and clade O, a newly discovered emm89 genetic variant, caused most cases of emm89 iGAS disease in metropolitan Toronto before 2008. After rapid emergence of new clade 3, previously circulating clades were purged from the population and the incidence of emm89 iGAS disease significantly increased from 0.14 per 100000 in 2000–2007 to 0.22 per 100000 in 2008–2014. Overall, emm89 organisms caused significantly more arthritis but less necrotizing fasciitis than strains of the more common type emm1. Other clinical presentations were soft tissue and severe respiratory tract infections. Clinical outcomes did not differ significantly between emm89 clades overall. However, clade 3 emm89 iGAS disease was more common in youth and middle-aged individuals. Conclusions The rapid shift in emm89 iGAS strain genetics in metropolitan Toronto has resulted in a significant increase in the incidence of emm89 iGAS disease, with noticeably higher rates of clade 3 disease in younger patients.

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

2015 ◽  
Vol 54 (1) ◽  
pp. 134-141 ◽  
Author(s):  
Karen Rudolph ◽  
Michael G. Bruce ◽  
Dana Bruden ◽  
Tammy Zulz ◽  
Alisa Reasonover ◽  
...  
Keyword(s):  
Vaccine Development ◽  
Case Fatality ◽  
Invasive Disease ◽  
Population Based ◽  
The Arctic ◽  
Surveillance Program ◽  
Bacterial Disease ◽  
Invasive Group ◽  
Laboratory Surveillance ◽  
Group A

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 51emmtypes were identified, of whichemm1 (11.1%) was the most prevalent, followed byemm82 (8.8%),emm49 (7.8%),emm12 andemm3 (6.6% each),emm89 (6.2%),emm108 (5.5%),emm28 (4.7%),emm92 (4%), andemm41 (3.8%). The five most commonemmtypes accounted for 41% of isolates. Theemmtypes 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.

scholarly journals Evaluating Household Transmission of Invasive Group A Streptococcus Disease in the United States Using Population-based Surveillance Data, 2013–2016

2019 ◽  
Author(s):  
Tolulope Adebanjo ◽  
Mirasol Apostol ◽  
Nisha Alden ◽  
Susan Petit ◽  
Amy Tunali ◽  
...  
Keyword(s):  
Index Case ◽  
Disease Risk ◽  
Group A Streptococcus ◽  
The United States ◽  
Population Based ◽  
Surveillance Data ◽  
Case Patient ◽  
Invasive Group ◽  
Household Transmission ◽  
Group A

Abstract Using population-based surveillance data, we quantified the secondary invasive group A Streptococcus disease risk among household contacts. The disease risk in the 30 days postexposure to an index-case patient was highest among individuals aged ≥65 years, versus the annual background incidence of all ages.

scholarly journals Canada-Wide Epidemic of emm74 Group A Streptococcus Invasive Disease

2018 ◽  
Vol 5 (5) ◽  
Author(s):  
Sarah Teatero ◽  
Allison McGeer ◽  
Gregory J Tyrrell ◽  
Linda Hoang ◽  
Hanan Smadi ◽  
...  
Keyword(s):  
Group A Streptococcus ◽  
Invasive Disease ◽  
Drug Usage ◽  
Rare Type ◽  
Invasive Group ◽  
Intravenous Drug Usage ◽  
Clinical Data Analysis ◽  
Invasive Infections ◽  
Group A ◽  
Canadian Provinces

Abstract Background The number of invasive group A Streptococcus (iGAS) infections due to hitherto extremely rare type emm74 strains has increased in several Canadian provinces since late 2015. We hypothesized that the cases recorded in the different provinces are linked and caused by strains of an emm74 clone that recently emerged and expanded explosively. Methods We analyzed both active and passive surveillance data for iGAS infections and used whole-genome sequencing to investigate the phylogenetic relationships of the emm74 strains responsible for these invasive infections country-wide. Results Genome analysis showed that highly clonal emm74 strains, genetically different from emm74 organisms previously circulating in Canada, were responsible for a country-wide epidemic of >160 invasive disease cases. The emerging clone belonged to multilocus sequence typing ST120. The analysis also revealed dissemination patterns of emm74 subclonal lineages across Canadian provinces. Clinical data analysis indicated that the emm74 epidemic disproportionally affected middle-aged or older male individuals. Homelessness, alcohol abuse, and intravenous drug usage were significantly associated with invasive emm74 infections. Conclusions In a period of 20 months, an emm74 GAS clone emerged and rapidly spread across several Canadian provinces located more than 4500 km apart, causing invasive infections primarily among disadvantaged persons.

scholarly journals Population‐Based Surveillance for Postpartum Invasive Group A Streptococcus Infections, 1995–2000

2002 ◽  
Vol 35 (6) ◽  
pp. 665-670 ◽  
Author(s):  
Ilin Chuang ◽  
Chris Van Beneden ◽  
Bernard Beall ◽  
Anne Schuchat ◽  
Keyword(s):  
Group A Streptococcus ◽  
Population Based ◽  
Invasive Group ◽  
Group A

scholarly journals Invasive group A Streptococcus disease in Australian children: 2016 to 2018 – a descriptive cohort study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jane Oliver ◽  
◽  
Elise Thielemans ◽  
Alissa McMinn ◽  
Ciara Baker ◽  
...  
Keyword(s):  
Disease Surveillance ◽  
Vaccine Development ◽  
Group A Streptococcus ◽  
Invasive Disease ◽  
Incidence Rates ◽  
Surveillance Systems ◽  
Invasive Group ◽  
Australian State ◽  
Life Threatening ◽  
Group A

Abstract Objectives Invasive group A Streptococcus (iGAS) disease is serious and sometimes life-threatening. The Paediatric Active Enhanced Disease Surveillance (PAEDS) Network collects voluntary notifications from seven major Australian paediatric hospitals on patients with certain conditions, including iGAS disease. Our aims were to: 1) Describe the epidemiological distribution of paediatric iGAS disease in Australia and correlate this with influenza notifications, 2) Identify GAS strains commonly associated with invasive disease in children. Methods IGAS and influenza notification data were obtained (from the PAEDS Network and the Australian Institute of Health and Welfare, respectively, for the period 1 July 2016 to 30 June 2018). Included iGAS patients had GAS isolated from a normally sterile body site. Data were described according to selected clinical and demographic characteristics, including by age group and Australian State, with proportions and minimum incidence rates estimated. Results A total of 181 patients were identified, with most (115, 63.5%) <5 years old. The mean annual minimum incidence rate was 1.6 (95% confidence interval: 1.1–2.3) per 100,000 children across the study period. An epidemiological correlation with the seasonal burden of influenza was noted. Contact prophylaxis was not consistently offered. Of 96 patients with emm-typing results available, 72.9% showed emm-1, −4 or − 12. Conclusions Robust surveillance systems and cohesive patient management guidelines are needed. Making iGAS disease nationally notifiable would help facilitate this. Influenza vaccination may contribute to reducing seasonal increases in iGAS incidence. The burden of disease emphasises the need for ongoing progress in GAS vaccine development.

scholarly journals The Shock of Strep: Rapid Deaths Due to Group a Streptococcus

2018 ◽  
Vol 8 (1) ◽  
pp. 136-149 ◽  
Author(s):  
Katrina M. Thompson ◽  
Alana K. Sterkel ◽  
Joseph A. McBride ◽  
Robert F. Corliss
Keyword(s):  
Streptococcus Pyogenes ◽  
Group A Streptococcus ◽  
Invasive Disease ◽  
Significant Morbidity ◽  
Invasive Group ◽  
Life Threatening ◽  
Group A ◽  
Severe Infections ◽  
Microscopic Findings ◽  
Positive Coccus

Streptococcus pyogenes, also known as group A beta-hemolytic strep, is a Gram positive coccus responsible for several million infections every year. The types of infections vary widely from pharyngitis to myositis, but all can advance to severe life threatening invasive disease. Of those infected, approximately 1100 to 1600 people die each year due to invasive disease. Why certain individuals contract severe infections is not known, but many strains of Streptococcus pyogenes are known to produce toxins and superantigens. Invasive Streptococcus pyogenes infections have been shown to cause significant morbidity and rapid mortality. In many cases, patients expire before full antemortem testing can be performed, causing physicians and families to look to forensic pathologists for answers. Understanding the pathogenesis of invasive group A strep infections, relevant gross and microscopic findings, and proper culturing techniques is critical for forensic pathologists to diagnosis this condition and assist in the education and protection of the communities they serve.

Increasing incidence of invasive group A streptococcus disease in New Zealand, 2002–2012: A national population-based study

2015 ◽  
Vol 70 (2) ◽  
pp. 127-134 ◽  
Author(s):  
Deborah A. Williamson ◽  
Julie Morgan ◽  
Virginia Hope ◽  
John D. Fraser ◽  
Nicole J. Moreland ◽  
...  
Keyword(s):  
New Zealand ◽  
Group A Streptococcus ◽  
Population Based ◽  
Population Based Study ◽  
Invasive Group ◽  
National Population ◽  
Group A

Bilateral periorbital necrotising fasciitis associated with invasive group: a Streptococcus infection

2020 ◽  
Vol 13 (12) ◽  
pp. e236800
Author(s):  
Grace Anne McCabe ◽  
Thomas Hardy ◽  
Thomas Gordon Campbell
Keyword(s):  
Group A Streptococcus ◽  
Early Recognition ◽  
Skin Grafting ◽  
Final Diagnosis ◽  
Necrotising Fasciitis ◽  
Invasive Group ◽  
Group A ◽  
Tissue Microscopy ◽  
Periorbital Swelling ◽  
Multidisciplinary Teamwork

A previously independent 56-year-old immunocompetent woman presented with septic shock in the setting of periorbital swelling and diffuse infiltrates on chest imaging. Blood cultures were positive for growth of group A Streptococcus (GAS). Broad spectrum antimicrobials were initiated with the inclusion of the antitoxin agent clindamycin. Necrosis of periorbital tissue was noted and surgical consultation was obtained. Débridement of both eyelids with skin grafting was performed. GAS was isolated from wound cultures and also observed on periorbital tissue microscopy. The final diagnosis was bilateral periorbital necrotising fasciitis (PONF) associated with invasive GAS infection. The patient had a prolonged intensive care unit course with input from multiple specialist teams. This case demonstrates the importance of early recognition and treatment of PONF, the profound systemic morbidity caused by these infections, and illustrates successful multidisciplinary teamwork.

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