scholarly journals Invasive Group A Streptococcal Infections Among People Who Inject Drugs and People Experiencing Homelessness in the United States, 2010–2017

2020 ◽  
Author(s):  
Sandra J Valenciano ◽  
Jennifer Onukwube ◽  
Michael W Spiller ◽  
Ann Thomas ◽  
Kathryn Como-Sabetti ◽  
...  
Keyword(s):  
Risk Factors ◽  
People Who Inject Drugs ◽  
Early Recognition ◽  
The United States ◽  
Streptococcal Toxic Shock Syndrome ◽  
Infection Rates ◽  
Invasive Group ◽  
Average Percentage ◽  
Skin Breakdown ◽  
Group A

Abstract Background Reported outbreaks of invasive group A Streptococcus (iGAS) infections among people who inject drugs (PWID) and people experiencing homelessness (PEH) have increased, concurrent with rising US iGAS rates. We describe epidemiology among iGAS patients with these risk factors. Methods We analyzed iGAS infections from population-based Active Bacterial Core surveillance (ABCs) at 10 US sites from 2010 to 2017. Cases were defined as GAS isolated from a normally sterile site or from a wound in patients with necrotizing fasciitis or streptococcal toxic shock syndrome. GAS isolates were emm typed. We categorized iGAS patients into four categories: injection drug use (IDU) only, homelessness only, both, and neither. We calculated annual change in prevalence of these risk factors using log binomial regression models. We estimated national iGAS infection rates among PWID and PEH. Results We identified 12 386 iGAS cases; IDU, homelessness, or both were documented in ~13%. Skin infections and acute skin breakdown were common among iGAS patients with documented IDU or homelessness. Endocarditis was 10-fold more frequent among iGAS patients with documented IDU only versus those with neither risk factor. Average percentage yearly increase in prevalence of IDU and homelessness among iGAS patients was 17.5% and 20.0%, respectively. iGAS infection rates among people with documented IDU or homelessness were ~14-fold and 17- to 80-fold higher, respectively, than among people without those risks. Conclusions IDU and homelessness likely contribute to increases in US incidence of iGAS infections. Improving management of skin breakdown and early recognition of skin infection could prevent iGAS infections in these patients.

scholarly journals Genital Tract GAS Infection ISIDOG Guidelines

2021 ◽  
Vol 10 (9) ◽  
pp. 2043
Author(s):  
Gilbert Donders ◽  
Peter Greenhouse ◽  
Francesca Donders ◽  
Ulrike Engel ◽  
Jorma Paavonen ◽  
...  
Keyword(s):  
Necrotizing Fasciitis ◽  
Toxic Shock Syndrome ◽  
Early Recognition ◽  
Supportive Therapy ◽  
Streptococcal Toxic Shock Syndrome ◽  
Toxic Shock ◽  
Aerobic Vaginitis ◽  
Invasive Group ◽  
Neonatal Deaths ◽  
Group A

There has been an increasing worldwide incidence of invasive group A streptococcal (GAS) disease in pregnancy and in the puerperal period over the past 30 years. Postpartum Group A streptococci infection, and in particular streptococcal toxic shock syndrome (TSS) and necrotizing fasciitis, can be life threatening and difficult to treat. Despite antibiotics and supportive therapy, and in some cases advanced extensive surgery, mortality associated with invasive group A streptococcal postpartum endometritis, necrotizing fasciitis, and toxic shock syndrome remains high, up to 40% of postpartum septic deaths. It now accounts for more than 75,000 deaths worldwide every year. Postpartum women have a 20-fold increased incidence of GAS disease compared to non-pregnant women. Despite the high incidence, many invasive GAS infections are not diagnosed in a timely manner, resulting in potentially preventable maternal and neonatal deaths. In this paper the specific characteristics of GAS infection in the field of Ob/Gyn are brought to our attention, resulting in guidelines to improve our awareness, early recognition and timely treatment of the disease. New European prevalence data of vaginal GAS colonization are presented, alongside two original case histories. Additionally, aerobic vaginitis is proposed as a supplementary risk factor for invasive GAS diseases.

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.

Group A β-Hemolytic Streptococcal Bacteremia: Historical Overview, Changing Incidence, and Recent Association With Varicella

PEDIATRICS ◽  
1995 ◽  
Vol 96 (3) ◽  
pp. 428-433
Author(s):  
Allan Doctor ◽  
Marvin B. Harper ◽  
Gary R. Fleisher
Keyword(s):  
Retrospective Chart Review ◽  
Streptococcal Toxic Shock Syndrome ◽  
Toxic Shock ◽  
Invasive Group ◽  
Exact Test ◽  
Physician Visits ◽  
Varicella Zoster ◽  
Group A ◽  
Occult Bacteremia ◽  
Bacterial Superinfection

Objective. To quantitate the increase in invasive group A β-hemolytic streptococcal (GABHS) infections and to define a possible association between GABHS bacteremia and primary varicella zoster virus (VZV) infections. Methods. This was a retrospective chart review conducted at Children's Hospital. Participants were patients with documented GABHS bacteremia occurring from January 1977 through December 1993. Measurements/Main Results. We identified 63 episodes of GABHS bacteremia in 62 patients. From 1977 to 1992, a mean of 3.2 ± 2 cases occurred per year (range, 0 to 6), increasing by a factor of 3 (10 cases) in 1993. The median age was 4 years (range, 1 day to 20 years; mean, 8 years ± 3 months); 36 were male; five children were immunocompromised. One child was dead on arrival and one had a cardiac arrest during evaluation in the emergency department. Primary sites of infection (oropharynx, skin, or middle ear) were identified in 40 (75%) of the cases; in addition, 10 cases occurred in patients with primary VZV. From 1977 to 1992, we identified five VZV-associated cases; an average of 7 ± 11.5% of the patients with GABHS had concurrent VZV infection annually, with no more than one case per year. In 1993, 50% of the 10 new GABHS cases were in children with VZV infection (P = .003, Fisher's exact test). The diagnosis of invasive GABHS infection in patients with VZV was not readily recognized, requiring a median of two (range, one to four) physician visits before admission and the administration of antibiotics. All 10 children were diagnosed on the fourth or fifth day of the exanthem and were febrile (39.6 ± 1.1°C, range, 38.3 to 40.8°C), with a mean white blood cell count (WBC) of 11 500 ± 8 400/mm3 (8 of 10 cases had a WBC less than 15 000/mm3). None of the five VZV-associated cases in 1993 had signs of cutaneous bacterial superinfection; among these were two cases of streptococcal toxic shock syndrome (one death), one case of osteomyelitis, and two cases of occult bacteremia. Of the five VZV-associated cases before 1993, one patient was diagnosed with supraglottitis, one with septic arthritis, one with orbital cellulitis, and two solely with impetiginized or cellulitic lesions. Conclusions. We found that the incidence of invasive GABHS infections has risen dramatically, increasing by a factor of 3 over the past year. In 1993, 50% of new cases of invasive GABHS disease were associated with VZV infection. Invasive GABHS should be considered in children with VZV who manifest fever on or beyond the fourth day of the exanthem. The absence of an elevated WBC and impetiginized or cellulitic lesions should not eliminate this diagnosis from consideration.

scholarly journals Sequential Quadriplex Real-Time PCR for Identifying 20 Common emm Types of Group A Streptococcus

2020 ◽  
Vol 59 (1) ◽  
pp. e01764-20
Author(s):  
Srinivasan Velusamy ◽  
Katherine Jordak ◽  
Madeline Kupor ◽  
Sopio Chochua ◽  
Lesley McGee ◽  
...  
Keyword(s):  
Real Time ◽  
Real Time Pcr ◽  
Group A Streptococcus ◽  
High Specificity ◽  
The United States ◽  
Rapid Identification ◽  
Invasive Group ◽  
Outbreak Investigations ◽  
Group A ◽  
Culture Negative

ABSTRACTWe developed a sequential quadriplex real-time PCR-based method for rapid identification of 20 emm types commonly found in invasive group A Streptococcus (iGAS) strains recovered through the Centers for Disease Control and Prevention’s Active Bacterial Core surveillance. Each emm real-time PCR assay showed high specificity and accurately identified the respective target emm type, including emm subtypes in the United States. Furthermore, this method is useful for rapid typing of GAS isolates and culture-negative specimens during outbreak investigations.

High burden of invasive group A streptococcal disease in the Northern Territory of Australia

2015 ◽  
Vol 144 (5) ◽  
pp. 1018-1027 ◽  
Author(s):  
R. BOYD ◽  
M. PATEL ◽  
B. J. CURRIE ◽  
D. C. HOLT ◽  
T. HARRIS ◽  
...  
Keyword(s):  
Indigenous Population ◽  
Case Series ◽  
Northern Territory ◽  
Molecular Characteristics ◽  
Streptococcal Toxic Shock Syndrome ◽  
Public Health Response ◽  
Diverse Range ◽  
Invasive Group ◽  
Streptococcal Disease ◽  
Group A

SUMMARYAlthough the incidence of invasive group A streptococcal disease in northern Australia is very high, little is known of the regional epidemiology and molecular characteristics. We conducted a case series of Northern Territory residents reported between 2011 and 2013 withStreptococcus pyogenesisolates from a normally sterile site. Of the 128 reported episodes, the incidence was disproportionately high in the Indigenous population at 69·7/100 000 compared to 8·8/100 000 in the non-Indigenous population. Novel to the Northern Territory is the extremely high incidence in haemodialysis patients of 2205·9/100 000 population; and for whom targeted infection control measures could prevent transmission. The incidences in the tropical north and semi-arid Central Australian regions were similar. Case fatality was 8% (10/128) and streptococcal toxic shock syndrome occurred in 14 (11%) episodes. Molecular typing of 82 isolates identified 28emmtypes, of which 63 (77%) were represented by fouremmclusters. Typing confirmed transmission between infant twins. While the diverse range ofemmtypes presents a challenge for effective coverage by vaccine formulations, the limited number ofemmclusters raises optimism should cluster-specific cross-protection prove efficacious. Further studies are required to determine effectiveness of chemoprophylaxis for contacts and to inform public health response.

Risk Factors in the Pathogenesis of Invasive Group A Streptococcal Infections: Role of Protective Humoral Immunity

1999 ◽  
Vol 67 (4) ◽  
pp. 1871-1877 ◽  
Author(s):  
Hesham Basma ◽  
Anna Norrby-Teglund ◽  
Yajaira Guedez ◽  
Allison McGeer ◽  
Donald E. Low ◽  
...  
Keyword(s):  
Risk Factors ◽  
Humoral Immunity ◽  
Streptococcal Infections ◽  
Invasive Group ◽  
Group A

scholarly journals LB9. Rising High Rate of Invasive Group A Streptococcus Infections Among Persons Experiencing Homelessness in San Francisco, 2010–2017

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S762-S762
Author(s):  
Tara Scheuer ◽  
Tanya Libby ◽  
Chris Van Beneden ◽  
James Watt ◽  
Arthur Reingold ◽  
...  
Keyword(s):  
United States ◽  
San Francisco ◽  
Group A Streptococcus ◽  
Disease Incidence ◽  
Case Fatality ◽  
The United States ◽  
Invasive Group ◽  
Incidence Trends ◽  
Disease Case ◽  
Group A

Abstract Background Rates of invasive group A Streptococcus (iGAS) disease in the United States have risen since 2014; reasons remain unclear. Outbreaks of iGAS infection among persons experiencing homelessness (PEH) and persons who inject drugs in Europe, Canada, and the United States have been described. Using active, population-based surveillance data from California’s Emerging Infections Program, we describe incidence trends and characteristics of iGAS infection among PEH and persons not experiencing homelessness (PNEH) in San Francisco (SF) County during 2010–2017. Methods We defined an iGAS case as infection with GAS isolated from a normally sterile site (e.g., blood) in an SF resident. We calculated annual iGAS disease incidence rates (cases per 100,000 population) for PEH and PNEH using denominators from SF’s Department of Homelessness and Supportive Housing and the State of California Department of Finance. Demographic, clinical, and exposure characteristics of PEH and PNEH were compared by chi-square or t-test. Results We identified 673 iGAS cases in SF during 2010–2017. Among these, 34% (229/673) were among PEH. Annual iGAS incidence among PEH rose from ~300 (2010–2014) to 547 (95% CI: 379–714) per 100,000 in 2017 (P < 0.001, Cochran-Armitage trend test); rates peaked at 758 (95% CI: 561–955) in 2016. Annual iGAS incidence in PNEH rose from a mean of 5 in 2010–2013 to 9.3 (95% CI: 7.3–11.4) per 100,000 in 2017 (P < 0.001). Annual iGAS incidence in PEH was 42–72 times that in PNEH. PEH with iGAS infections were significantly younger and more likely to be male, white, and uninsured or enrolled in Medicaid (P < 0.05 for each) compared with PNEH with iGAS disease. Case fatality ratios, ICU admission, infection type, and length of hospital stay did not differ significantly. Smoking, current injection drug use, current alcohol abuse, and AIDS diagnosis were significantly more common among PEH with iGAS. Obesity, diabetes, and cancer were significantly more common among PNEH with iGAS. Conclusion In San Francisco, iGAS rates among both PEH and PNEH have risen significantly. Incidence of iGAS is strikingly higher in PEH than in PNEH and exposures differed between PEH and PNEH with iGAS. This information could inform development of disease control and prevention strategies. Disclosures All authors: No reported disclosures.

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