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PubMed1999

Invasive group A streptococcal infections in children.

Invasive group A streptococcal infections and STSS have increased as causes of morbidity and mortality among children and adults. In children, respiratory foci appear to be the most common, but skin and soft tissue infection, particularly associated with varicella, also are common. Early diagnosis requires awareness of the presenting features and a high index of suspicion. Antimicrobial therapy that includes clindamycin, therapy with IVIG for those with STSS, and surgical intervention for patients with necrotizing fasciitis may improve outcome. Chemoprophylaxis should be considered among household contacts of patients with severe group A streptococcal disease in high-risk settings. Further studies are ongoing to evaluate the hypothesized link of invasive group A streptococcal infection in children with varicella and NSAID use, to better clarify the pathogenesis of STSS and necrotizing fasciitis, and to better document the risk of secondary spread among close contacts of case patients.

Adolescent↗
PubMed2001

A 7-month outbreak of relapsing postpartum group A streptococcal infections linked to a nurse with atopic dermatitis.

A 7-month outbreak of 15 cases of postpartum sepsis with group A haemolytic Streptococci (GAS) was stopped when a carrier was identified. Comparing delivery dates with duty rotas revealed that the carrier had been present during delivery in 13 of the 15 cases. The epidemic GAS type, T3-13-B3264, was found in a carbuncle in her groin and in atopic dermatitis lesions behind her ears and on her eyelids. Thus, it was not the microbiological screening of staff that helped detect the carrier. The outbreak went unnoticed for 6 months, as no 2 cases were diagnosed by the same physician and 5 cases were diagnosed by different general practitioners. The main risk factors for infection were presence of the carrier relative risk (relative risk RR 47.8, 95% confidence interval (CI) 10.9-209.5) and suturing of episiotomy (RR 11.0; 95% CI 2.6-47.9). We recommend that a thorough epidemiological investigation should be carried out in every single case of GAS postpartum infection. Despite initial intravenous treatment with penicillin, 8 patients experienced > 15 recurring postpartum GAS infections, such as endometritis, wound infection, tonsillitis, erysipelas and Brodie's abscess. Eradication of GAS should be confirmed after completion of treatment.

Adult↗
PubMed1960

Host-parasite factors in group A streptococcal infections. A comparative study of streptococcal pyrogenic toxins and gram-negative bacterial endotoxin.

THE DATA PRESENTED IN THIS STUDY SUGGEST THAT GROUP A STREPTOCOCCI PRODUCE TWO DISTINCT PYROGENIC TOXINS: one primarily an intracellular toxin and the other mainly an extracellular toxin. Both of these toxins are not extractable by the conventional methods, phenol and TCA, used for isolation of Gram-negative bacterial endotoxin. Their chemical composition, therefore, differs from that of Gram-negative bacterial endotoxin. On the basis of tolerance studies it appears that similar non-specific host factors may be involved in the detoxification of both the streptococcal intracellular pyrogenic toxin and the Gram-negative bacterial endotoxin. Detoxification of streptococcal exotoxin requires a more immunologically specific mechanism. Because all the Group A sonic extracts studied elicited reciprocal tolerance to one another, it is suggested that tolerance to the intracellular pyrogenic toxin is not correlated with type-specificity.

Animals↗
PubMed1988

Lung antibacterial defense mechanisms in infant and adult rats: implications for the pathogenesis of group B streptococcal infections in the neonatal lung.

We investigated factors that may contribute to lung infections in infants by studying the intrapulmonary responses to aerosols of three different types of organisms--group B streptococcus with and without type-specific capsule, Pseudomonas aeruginosa, and Staphylococcus aureus--in infant (12-h-old or 24-36-h-old) and adult (150 g, 6-w-old) rats. After aerosol exposure, the lung clearance rate of each organism varied inversely with the age of the animals, and the magnitude of the clearance defect was related more strongly to animal age than to the bacterial species. Fewer alveolar macrophages from infant animals phagocytosed each type of organism in vivo, and the rate of neutrophil accumulation in the lungs of infant animals was delayed. The neonatal lung functioned effectively, however, as an antibacterial barrier, as newborn animals survived an aerosolized inoculum that exceeded the LD50 by the subcutaneous route.

Aerosols↗