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PubMed1992

[Epidemiology and pathogenesis of streptococcal infection].

The appearance of the "streptococcal toxic shock-like syndrome" led to a growing interest in infections caused by Streptococcus pyogenes (group-A-streptococci). Since 1987 some 800 cases with a lethality of 20% or more were observed. Contrary to toxic scarlet fever the site of primary infection are the lower respiratory tract or soft tissue infections. Erythrogenic toxins and low molecular weight mitogens, inducing cytokines (IL-2, IL-3, IL-6, TNF-alpha, IFN-gamma) seem to be involved in the pathogenesis of these severe infections. Morphologically and culturally the strains isolated from cases of toxic shock-like syndrome cannot be differentiated from isolates of epidemic scarlet fever or sporadic cases. At the same time, when in Scandinavia an epidemic by S.pyogenes type 1 with many cases of toxic shock was observed, the same type caused a scarlet fever epidemic without complications in eastern Germany. Erythrogenic toxin type A or its toxoid, respectively, can be used for successful immunizations of rabbits. Another--antibacterial-immunization can be done with the M-protein of S.pyogenes, which is limited by its type-specificity. Streptococcal vaccination is required especially for developing countries with a high incidence of rheumatic fever. Infections due to Streptococcus agalactiae (group-B streptococci) are often underestimated though they have a first position in septicemia and meningitis of newborns. Taxonomy and nomenclature of streptococci are often changing; a list of the presently known species is presented in table I.

Animals↗
PubMed1993

Serious group A streptococcal infections complicating cryotherapy to lip haemangiomas.

Cryotherapy is a safe and effective way of treating haemangiomas of the oval cavity and lips without complications in adults in a reported series. Two cases of serious group A streptococcal infection after cryotherapy in two children are reported. In conclusion it is likely that these children were undiagnosed carriers for the organism. Pre-operative nasopharyngeal swabs would have identified this and prevented the complications which occurred.

Child, Preschool↗
PubMed1977

Comparative study of antistreptolysin O, antideoxyribonuclease B and multienzyme tests in streptococcal infections.

The results of antistreptolysin O (ASO), antideoxyribonuclease B (ADB), and a multienzyme test, Streptozyme, with 162 sera from a stratified random sample of Wisconsin school children, and specimens routinely submitted for serodiagnosis of Group A streptococcal infections are described. A review of the results of Streptozyme tests of laboratories participating in the State Division of Health Proficiency Testing Program, is also presented. The results of these various tests have revealed both false positive and false negative results with the Streptozyme procedure. Although there was good correlation of the Streptozyme findings with the ASO and ADB tests results with sera from young children, false positive Streptozyme test results increased with age of the study subjects. Our results with the ADB test on sera from apparently normal Wisconsin children and young adults suggest that the upper limits of normal ADB values, suggested by the manufacturers of commercial ADB test kits, may be too low.

Adolescent↗
PubMed2004

Successful antimicrobial therapy and implant retention for streptococcal infection of prosthetic joints.

BACKGROUND: Streptococci cause up to 20% of prosthetic joint infections but this has received little attention in the published literature. METHODS: We reviewed retrospectively our experience with treatment of streptococcal prosthetic joint infections. Patients were followed up for up to 15 years after discontinuation of antimicrobial therapy and up to 8.5 years while on continuous antimicrobial therapy. RESULTS: Eighteen cases were diagnosed between 1984 and 1995. These included one group A, seven group B, one group D, seven group G and one viridans-group streptococcal infection as well as one group B and D streptococcal co-infection. All were late-onset infections and most (11 of 18, 61%) were acute. Hip and knee joints were equally affected. Six of seven group G streptococcal infections were associated with skin or soft tissue infections. Sixteen patients were treated primarily with antimicrobial agents including 5 days to 6 weeks given intravenously and 2 weeks to 8.5 years given orally. At latest follow up, 10 patients had been off antimicrobial therapy for at least 18 months without relapse, one patient had been off antimicrobial therapy for 7 months without relapse and four infections were successfully controlled with long-term suppressive antimicrobial therapy. One infection was unable to be controlled with antimicrobial therapy. CONCLUSIONS: Our results, and those of others, show that prosthetic joint infections caused by streptococci have a relatively good outcome with primary antimicrobial therapy and, when necessary, drainage, lavage or debridement. Provided the prosthesis is stable and the patient can tolerate long-term antimicrobial therapy, this may be an effective alternative to excision arthroplasty.

Adult↗
PubMed1988

Correlation of clinical and pathologic findings in early onset neonatal group B streptococcal infection with disease severity and prediction of outcome.

This study analyzed the clinical characteristics of 69 neonates who were admitted to the University of Minnesota Hospital between January, 1972, and June, 1984, with early onset Group B streptococcal infection (EOGBS) and determined those features associated with fatal infection. The incidence of EOGBS was 1.6 cases/1000 live births among 7960 inborn infants; the mortality rate for inborn and outborn infants was 28%. Multivariate analysis identified five features adequately predicting fatal outcome: birth weight less than 2500 g, absolute neutrophil count less than 1500 cells/mm3, hypotension, apnea and a pleural effusion on the initial chest radiographs. With these five variables and an initial blood pH less than 7.25, a clinical score was constructed that correctly predicted outcome in 93% of patients in this study (87% sensitivity, 95% specificity). Autopsy findings in 16 of 19 infants with fatal EOGBS suggested that surfactant deficiency respiratory distress syndrome was common in preterm infants with EOGBS and contributed to their higher mortality compared with term infants.

Birth Weight↗
PubMed1995

Myositis and fasciitis associated with group A beta hemolytic streptococcal infections: development of a rabbit model.

Group A streptococci produce a variety of clinical symptoms ranging from minor pharyngeal infections to life-threatening soft-tissue disease. A rabbit model is described for induction of myonecrosis and fasciitis with group A beta-hemolytic streptococci. Group A streptococcal infections have shown remarkable virulence in recent years, resulting in severe local tissue destruction and life-threatening toxicity. After subcutaneous injection into the thigh of 20 ml broth containing 10(5) to 10(9) cfu/ml, initial soft tissue infection rapidly progressed to rhabdomyolysis. The response of the rabbits to the infection was consistent with the human response.

Adult↗
PubMed2005

Invasive group A streptococcal infection with pancarditis caused by a new emm-type 12 allele of Streptococcus pyogenes.

Throughout the 1980s, a progressive increase in the incidence of Streptococcus pyogenes-related invasive infections has occurred. It has been suggested that a host-related immunogenetic background, as well as bacterial virulence factors may play an important role in the outcome of streptococcal infections. Here, we present the first case of pancarditis in the literature caused by direct bacterial invasion due to a new emm-type 12 allele of S. pyogenes in an immunocompetent patient. The pathogenesis of this invasive infection, as well as predictors of poor prognosis are discussed.

Adult↗
PubMed1976

Group B streptococcal infection in the newborn. Criteria for early detection and treatment.

Recent reports indicate that the group B haemolytic streptococcus has now assumed a major role in neonatal septicaemia in the United Kingdom. Of particular concern are the absence of premonitory signs, the fulminating nature of the infection and the high mortality. 31 cases from which this organism was isolated during the first week of life included 5 cases of neonatal septicaemia, 4 of which proved fatal. An attempt was made (a) to identify the group of neonates at greatest risk and (b) to formulate guidelines for early detection and treatment. Study indicates the importance of apnoea as a sign of infection particularly in those infants who are preterm, of low birth weight and asphyxiated. There is need for aggressive bacteriological screening and early administration of antibiotics to prevent the high mortality from group B streptococcal infection.

Diseases in Twins↗
PubMed1995

Group B streptococcal infections in the perinatal period: current approaches.

Group B streptococcal (GBS) infection in the neonate is the most common infectious cause of perinatal morbidity and mortality. There is much confusion in the literature regarding screening and treatment for this disease. The authors review recent literature on perinatal GBS infection and present their clinical opinions in favor of routine screening during pregnancy. Treatment protocols for the GBS positive mother, as well as the infant delivered of a GBS positive mother are considered.

Diagnosis, Differential↗
PubMed1955

The use of precipitin analysis in agar for the study of human streptococcal infections. II. Ouchterlony and Oakley technics.

It has been shown by agar precipitin tests (Ouchterlony and Oakley) that human sera may contain from 0 to 5 antibodies against antigens present in a partially purified streptolysin O preparation, and from 0 to 7 antibodies against antigens in a crude ammonium sulfate concentrate of the streptococcal culture supernate used. These antigens were prepared from a Group A hemolytic streptococcus (strain C203S). Strong evidence was presented suggesting that some of the bands seen with streptolysin O concentrate represented antibody reponses to streptococcal antigens heretofore undescribed. Tests were also carried out with other streptococcal antigens, including streptokinase-desoxyribonuclease mixture from Group C streptococci (varidase-Lederle), crystalline proteinase, proteinase precursor, C carbohydrate, and sonic vibrated streptococcal cell extracts (group A, C203S). Fewer bands were seen with these preparations, and with some they were quite uncommon. The observations indicated that the predominating antibody responses in human streptococcal infections were to extracellular products of the micro-organisms, and only very slightly and infrequently to intracellular antigens. The human sera studied included sera from patients with active or convalescent rheumatic fever, and non-rheumatic subjects suffering from a variety of illnesses. As was expected, the rheumatic subjects showed antibody responses to many more of the antigens present in these preparations than did the nonrheumatic group. Pooled normal human gamma globulin was found to contain many of the antibodies found in potent human sera. This finding confirmed the antigen-antibody nature of the bands seen with individual sera. The epidemiological significance of these findings with gamma, globulin was briefly discussed. It was found that rabbit, guinea pig, and human antibody precipitin bands join quite readily in the Ouchterlony tests. This finding adds another tool for the identification of the precipitin bands found with human sera. Evidence was obtained which indicated differing immunological specificities of two samples of streptococcal desoxyribonuclease, one from Group A, the other from a Group C streptococcus. The value of these technics as representing a new approach to the study of human infectious disease was discussed.

Agar↗
PubMed1980

An outbreak of streptococcal infection in a chicken factory.

A large outbreak of streptococcal skin infection occurred late in the summer of 1978 in a factory which undertakes the slaughter, preparation and packing of chickens. In all, 103 episodes of infection occurred in 82 workers from a total factory establishment of 347. The highest incidence of infection was in the packing department where there was an attack rate of 44%. The routes of introduction of infection into and spread within the factory remain mostly unknown. Following the identification of cases and carriers and the institution of appropriate treatment and control measures the outbreak quickly declined. The responsible organism in the outbreak was Streptococcus pyogenes T-type 3/13/B3264, provisional M-type 'R78/55'. This is the first poultry factory outbreak in England to be reported.

Animals↗
PubMed2004

Plasminogen is a critical host pathogenicity factor for group A streptococcal infection.

Group A streptococci, a common human pathogen, secrete streptokinase, which activates the host's blood clot-dissolving protein, plasminogen. Streptokinase is highly specific for human plasminogen, exhibiting little or no activity against other mammalian species, including mouse. Here, a transgene expressing human plasminogen markedly increased mortality in mice infected with streptococci, and this susceptibility was dependent on bacterial streptokinase expression. Thus, streptokinase is a key pathogenicity factor and the primary determinant of host species specificity for group A streptococcal infection. In addition, local fibrin clot formation may be implicated in host defense against microbial pathogens.

Ancrod↗
PubMed2002

An immunogenetic and molecular basis for differences in outcomes of invasive group A streptococcal infections.

The role of host genetic factors in conferring predisposition or protection in infectious diseases has become evident. Infection with group A streptococci causes a wide spectrum of disease ranging from pharyngitis to streptococcal toxic shock syndrome. The release of inflammatory cytokines triggered by streptococcal superantigens has a pivotal role in invasive streptococcal disease. However, individuals infected with the same strain can develop very different manifestations. We report here that the immunogenetics of the host influence the outcome of invasive streptococcal infection, and demonstrate the underlying mechanism for these genetic associations. Specific human leukocyte antigen class II haplotypes conferred strong protection from severe systemic disease, whereas others increased the risk of severe disease. Patients with the DRB1*1501/DQB1*0602 haplotype mounted significantly reduced responses and were less likely to develop severe systemic disease (P < 0.0001). We propose that human leukocyte antigen class II allelic variation contributes to differences in severity of invasive streptococcal infections through their ability to regulate cytokine responses triggered by streptococcal superantigens.

Fasciitis, Necrotizing↗
PubMed2005

Immune response to a laminin-binding protein (Lmb) in group A streptococcal infection.

BACKGROUND: A laminin-binding protein (Lmb) similar to that of group B streptococcus is conserved in group A streptococcus (GAS) and has a role in adhesion of GAS to epithelial cells. The role of this protein is yet to be clarified in disease process and thus, it is important to know its role in binding of GAS to laminin and the immunogenic response against it in patients related with GAS infection. METHODS: A recombinant protein (rGAS-Lmb) was purified using the lmb gene from M1 GAS and tested for its role in binding of GAS with laminin. The antibody response against rGAS-Lmb in patient sera related with GAS infection was measured by ELISA. RESULTS: The rGAS-Lmb bound with laminin directly and inhibited the binding of GAS to laminin. The antibody response against rGAS-Lmb in patients with uncomplicated streptococcal infection (U. Strep) and those with rheumatic fever (RF) were significantly higher than those in the control group (P < 0.0001 and P < 0.001, respectively). No difference of anti-rGAS-Lmb antibody titer could be found between these two disease groups. CONCLUSION: The higher antibody response in patients with GAS infection implies that the protein is well expressed during the period of infection and may be related with the colonization and infection of GAS in pharyngeal mucosa.

Adhesins, Bacterial↗
PubMed1997

Identification of children with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections by a marker associated with rheumatic fever.

OBJECTIVE: The authors' goal was to determine whether a trait marker of rheumatic fever susceptibility (labeled D8/17) could identify children with pediatric autoimmune neuropsychiatric disorders (obsessive-compulsive disorder and tic disorders) associated with streptococcal infections (PANDAS). METHOD: Blood samples obtained from 27 children with PANDAS, nine children with Sydenham's chorea, and 24 healthy children were evaluated for D8/17 reactivity. Individuals were defined as D8/17 positive if they had 12% or more D8/17+ cells. RESULTS: The frequency of D8/17-positive individuals was significantly higher in both patient groups than it was among the healthy volunteers: 85% of the children with PANDAS and 89% of the children with Sydenham's chorea, compared with 17% of the healthy children, were D8/17 positive. Further, the mean number of D8/17+ cells was similar in the two patient groups and was significantly higher in these groups than in the group of healthy children. CONCLUSIONS: These results suggest that there may be a subgroup of D8/17-positive children who present with clinical symptoms of obsessive-compulsive disorder and Tourette's syndrome, rather than Sydenham's chorea, but who have similar poststreptococcal autoimmunity.

Adolescent↗