scholarly journals Invasive Group A Streptococcal Infections: Benefit of Clindamycin, Intravenous Immunoglobulins and Secondary Prophylaxis

2021 ◽  
Vol 9 ◽  
Author(s):  
Delphine Laho ◽  
Sophie Blumental ◽  
Anne Botteaux ◽  
Pierre R. Smeesters
Keyword(s):  
Clinical Studies ◽  
Secondary Infection ◽  
Secondary Prophylaxis ◽  
Added Value ◽  
Streptococcal Toxic Shock Syndrome ◽  
Streptococcal Infections ◽  
Invasive Group ◽  
Household Contacts ◽  
Increased Risk ◽  
Group A

Introduction: Mortality associated with invasive group A streptococcal infections (iGAS) remains high among adults, with lower mortality in children. The added value of both clindamycin and immunoglobulins in such treatment is still controversial, as is the need for antibiotic secondary prophylaxis. It is unlikely that conclusive randomized clinical studies will ever definitively end these controversies.Materials and Methods: A clinical and experimental literature review was conducted in Pubmed, Cochrane, and lay literature to determine the benefit of adding clindamycin and immunoglobulins to β-lactams in the management of iGAS, as well as the need for secondary prophylaxis measures in close contacts.Results: This review includes two meta-analyses, two randomized controlled trials, four prospective studies, five retrospective studies, and microbiological studies. To reduce mortality and morbidity, it appears useful to add clindamycin to β-lactams in severe clinical presentations, including necrotizing fasciitis or streptococcal toxic shock syndrome, and immunoglobulins for the latter two presentations. The high risk of secondary infection in household contacts justifies the need of taking preventive measures.Conclusions: Both clinical studies and available experimental evidence suggest that adding clindamycin and immunoglobulins as adjunctive therapies in the management of invasive group A streptococcal infections may reduce mortality. Household contacts should be warned about the increased risk of secondary infection, and chemoprophylaxis may be considered in certain situations.

scholarly journals 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):  
Neutralizing Antibodies ◽  
Streptococcal Infection ◽  
Host Susceptibility ◽  
Streptococcal Toxic Shock Syndrome ◽  
Invasive Infection ◽  
Streptococcal Infections ◽  
Invasive Group ◽  
Invasive Infections ◽  
Protective Antibodies ◽  
Group A

ABSTRACT An impressive change in the epidemiology and severity of invasive group A streptococcal infections occurred in the 1980s, and the incidence of streptococcal toxic shock syndrome cases continues to rise. The reason for the resurgence of severe invasive cases remains a mystery—has there been a change in the pathogen or in host protective immunity? To address these questions, we have studied 33 patients with invasive infection caused by genotypically indistinguishable M1T1 strains of Streptococcus pyogenes who had different disease outcomes. Patients were classified as having severe (n= 21) and nonsevere (n = 12) invasive infections based on the presence or absence of shock and organ failure. Levels of anti-M1 bactericidal antibodies and of anti-streptococcal superantigen neutralizing antibodies in plasma were significantly lower in both groups than in age- and geographically matched healthy controls (P < 0.01). Importantly, the levels of these protective antibodies in plasma samples from severe and nonsevere invasive cases were not different. Together the data suggest that low levels of protective antibodies may contribute to host susceptibility to invasive streptococcal infection but do not modulate disease outcome. Other immunogenetic factors that regulate superantigen responses may influence the severity of systemic manifestations associated with invasive streptococcal infection.

scholarly journals Opsonic Antibodies to the Surface M Protein of Group A Streptococci in Pooled Normal Immunoglobulins (IVIG): Potential Impact on the Clinical Efficacy of IVIG Therapy for Severe Invasive Group A Streptococcal Infections

1998 ◽  
Vol 66 (5) ◽  
pp. 2279-2283 ◽  
Author(s):  
Hesham Basma ◽  
Anna Norrby-Teglund ◽  
Allison McGeer ◽  
Donald E. Low ◽  
Omar El-Ahmedy ◽  
...  
Keyword(s):  
Ivig Therapy ◽  
M Protein ◽  
Enzyme Linked Immunosorbent Assay ◽  
Streptococcal Toxic Shock Syndrome ◽  
Group A Streptococci ◽  
Streptococcal Infections ◽  
Opsonic Activity ◽  
Invasive Group ◽  
Significant Difference ◽  
Group A

ABSTRACT The surface M protein of group A streptococci (GAS) is one of the major virulence factors for this pathogen. Antibodies to the M protein can facilitate opsonophagocytosis by phagocytic cells present in human blood. We investigated whether pooled normal immunoglobulin G (IVIG) contains antibodies that can opsonize and enhance the phagocytosis of type M1 strains of GAS and whether the levels of these antibodies vary for different IVIG preparations. We focused on the presence of anti-M1 antibodies because the M1T1 serotype accounts for the majority of recent invasive GAS clinical isolates in our surveillance studies. The level of anti-M1 antibodies in three commercial IVIG preparations was determined by enzyme-linked immunosorbent assay (ELISA), and the opsonic activity of these antibodies was determined by neutrophil-mediated opsonophagocytosis of a representative M1T1 isolate. High levels of opsonic anti-M1 antibodies were found in all IVIG preparations tested, and there was a good correlation between ELISA titers and opsonophagocytic activity. However, there was no significant difference in the levels of opsonic anti-M1 antibodies among the various IVIG preparations or lots tested. Adsorption of IVIG with M1T1 bacteria removed the anti-M1 opsonic activity, while the level of anti-M3 opsonophagocytosis was unchanged. Plasma was obtained from seven patients with streptococcal toxic shock syndrome who received IVIG therapy, and the level of anti-M1 antibodies was assessed before and after IVIG administration. A significant increase in the level of type M1-specific antibodies was found in the plasma of all patients who received IVIG therapy (P < 0.006). The results reveal another potential mechanism by which IVIG can ameliorate severe invasive group A streptococcal infections.

Invasive Group A Streptococcal infections in children

2020 ◽  
Vol 16 ◽  
Author(s):  
Molla Imaduddin Ahmed ◽  
Rosalind V Saunders ◽  
Srini Bandi
Keyword(s):  
Early Diagnosis ◽  
Management Practices ◽  
Clinical Presentation ◽  
Streptococcal Infections ◽  
Invasive Group ◽  
Children's Hospital ◽  
Good Outcome ◽  
Children’S Hospital ◽  
Group A

: We reviewed the clinical presentation and management of children with Invasive group A streptococcal infections admitted to our tertiary Children’s Hospital in the last eight years. Our study highlighted the varied symptomatology and management practices in children with iGAS and showed that early diagnosis and prompt initiation of appropriate antibiotics for iGAS can help in resolution of symptoms and good outcome.

Invasive Group A Streptococcal Infections in a Large Tertiary Center: Epidemiology, Characteristics and Outcome

Infection ◽  
2002 ◽  
Vol 30 (2) ◽  
pp. 81-85 ◽  
Author(s):  
R. Ben-Abraham ◽  
N. Keller ◽  
R. Vered ◽  
R. Harel ◽  
Z. Barzilay ◽  
...  
Keyword(s):  
Streptococcal Infections ◽  
Invasive Group ◽  
Tertiary Center ◽  
Group A

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.

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