[Group B Streptococcus infections: new forms. New preventive measures].
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Humans↗
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Subpectoral abscess a rare group A beta-hemolytic Streptococcus infection.
Suppurative complications of group A beta-hemolytic Streptococcus infection can present acutely and progress rapidly if prompt treatment is not initiated. Awareness of uncommon presentations is essential. We report a patient with a rare form of group A beta-hemolytic Streptococcus disease, subpectoral abscess.
Abscess↗
Beta-haemolytic Streptococcus infection in burns.
Group A beta haemolytic Streptococcus has been one of the most serious infections in the burn patients resulting in severe cellulitis and sepsis. Penicillin has been used ever since its introduction as prophylaxis against these conditions. Penicillin prophylaxis was used in our burn unit as well without any serious evaluation until December 1992. This prospective study was therefore, undertaken to evaluate the incidence of beta haemolytic Streptococcus infection in burn patients, and its clinical outcome over a period of 5 years in the absence of prophylaxis with penicillin. 14 of the 1213 burn patients admitted to the Al-Babtain Centre for Plastic Surgery and Burns from January 1993 to December 1997 had either colonization or infection with Streptococcus spp. Their mean age was 15 years (range 1 month to 52 years) and the mean burn surface area was 20% (range 5 to 90%). Streptococci were isolated from burn wounds in 10 patients, throat in 3 and blood culture in 1. Group A Streptococcus was found in 5, group C in 3 and group D in 6 patients. In all patients except one the organisms were isolated > or =72 h post burn. The infections were successfully controlled by antibiotic and no detrimental effect was observed either on wound healing or skin graft take. There was no mortality amongst these 14 patients. The study showed that only 1.1% of the burn patients in our unit acquired Streptococcus of which only one third comprised of group A. This study thus demonstrates that the practice of penicillin prophylaxis during the first five post burn days may not be of any value and therefore, deserves discontinuation in units where the incidence of this organism is minuscule.
Adult↗
[Three cases of hemolytic Streptococcus infection in guinea-pigs (author's transl)].
Three cases of naturally occurring hemolytic streptococcus infection were detected in guinea-pigs which had been delivered from different sources to the Division of Animal Research, Faculty of Medicine, University of Tokyo, Tokyo, during the period from November, 1976, till February, 1977. The clinical manifestations of the infection were differentiated into two types; ie, the acute type with sepsis and pneumonia as main pathologic changes, and the chronic type with abscess formation of submaxillary lymph node. Streptococcus zooepidemicus was isolated from the conjunctiva of about 56% of these guinea-pigs. Healthy guinea-pigs housed with spontaneously infected ones in the same cage suffered from the infection, showing manifestation and pathologic changes similar to the spontaneous cases. Some of them, however, remained apparently healthy for about 2 months harboring the organisms in the conjunctiva or nasal cavity. It is presumed that such carriers become a source of the infection in nature.
Animals↗
[Prophylaxis and treatment of streptococcus infections (author's transl)].
Authors review and bring up to date problems related to prophylaxis and treatment of streptococcus infections in children. In those caused by the Group A streptococcus, the problem is rather one of medical education and practical application of techniques, and medicines. Active vaccination is still a remote possibility. In the case of streptococcus B and its perinatological incidence, there is still no standard therapeutic prophylaxis covering both the mother and child. With reference to streptococcus D plans proposed are somewhat discordant since it is difficult to carry out studies with sufficiently large groups but there are also proposals which can be carried out perfectly well and are reasonably safe. As far as the infectious, and to a great extent contagious, processes are concerned, measures of individual and collective hygiene are particularly important.
Anti-Bacterial Agents↗
Invasive group A streptococcus infection of the scrotum and streptococcal toxic shock syndrome.
We report a case of invasive group A streptococcus infection of the scrotum that presented as epididymoorchitis and rapidly progressed to streptococcal toxic shock syndrome. The presentation, pathophysiology, and management of invasive group A streptococcus and streptococcal toxic shock syndrome are reviewed. Rapid recognition is necessary to avoid the significant morbidity and mortality associated with these invasive infections.
Adolescent↗
Prevention of group B Streptococcus infection in neonates.
OBJECTIVE: To review the epidemiology of group B Streptococcus (GBS) infection, risk factors for infection, and clinical manifestations of disease in the neonate, as well as the role of chemoprophylaxis and immunoprophylaxis in prevention of GBS disease and current recommendations for prevention. DATA SOURCES AND STUDY SELECTION: MEDLINE searchers (1976-1997) of the English-language literature. DATA SYNTHESIS: Despite clinical advances in health care in the past two decades, GBS remains a leading cause of serious neonatal infection. Most early-onset GBS infections can be prevented through the use of intrapartum antimicrobial chemoprophylaxis. Preventing GBS infection in neonates is more cost-effective than treating GBS infections, and implementing prevention programs can reduce morbidity and mortality resulting from GBS disease. Many proposals have been made regarding prevention strategies; however, they have not been implemented widely and consistently in the US. To coordinate both pediatric and obstetric supported strategies, the Centers for Disease Control and Prevention (CDC) recently published recommendations for prevention of neonatal GBS disease through two possible strategies. In the first strategy, intrapartum antibiotic chemoprophylaxis should be offered to all women identified by prenatal culture as colonized and those who develop premature membrane rupture or onset of labor at less than 37 weeks gestation. The second strategy involves administration of intrapartum antibiotics to all women who develop one or more risk factors at the time of membrane rupture or onset of labor. CONCLUSIONS: GBS is difficult to eradicate, causing many women to be colonized with the organism during pregnancy and labor, thereby infecting their infant. Prevention strategies have been published for more than 10 years without successful implementation. Although optimal prevention management has not been defined, following one of two strategies recommended by the CDC can prevent the majority of GBS infections in neonates.
Antibiotic Prophylaxis↗
Inhibition of group A streptococcus infection by carboxyfullerene.
The effect of a water-soluble trimalonic acid derivative of fullerene, carboxyfullerene, against Streptococcus pyogenes infection was tested. Pretreatment with carboxyfullerene was able to protect mice from S. pyogenes infection in an air pouch model. S. pyogenes-induced death and skin injury were inhibited dose dependently by carboxyfullerene. Administration of carboxyfullerene via the peritoneum and air pouch at 3 h post-S. pyogenes infection was able to protect 33% of mice from death. Surveys of exudates of the air pouch of carboxyfullerene-treated mice revealed that survival of infiltrating neutrophils was prolonged and that the bacteria were eliminated as a result of enhanced bactericidal activity of the neutrophils. Furthermore, carboxyfullerene was able to directly inhibit in vitro growth of S. pyogenes. These data suggest that carboxyfullerene can be considered an antimicrobial agent for group A streptococcus infection.
Animals↗
Invasive group A streptococcus infections.
The late 1980s have witnessed the emergence of severe group A streptococcus (GAS) infection; shock, bacteremia, and acute respiratory distress syndrome are common features, and death has been associated with this infection in 30% of patients. Such infections have now been described in all parts of the United States, Europe, and Australia and have occurred predominantly in otherwise healthy adolescents and adults. The characteristic clinical and laboratory features of the streptococcal toxic shock syndrome include deep-seated infection associated with shock and multiorgan failure. Strains of GAS isolated from patients with invasive disease have been predominantly M types 1 and 3, which produce pyrogenic exotoxin A or B or both. In this report, the clinical and demographic features of streptococcal bacteremia, myositis, and necrotizing fasciitis will be presented and compared with those of streptococcal toxic shock syndrome. Current concepts of the pathogenesis of invasive streptococcal infection will also be presented in terms of the interaction between virulence factors of GAS and host defense mechanisms. Finally, new concepts for future treatment of serious streptococcal infections will be proposed.
Bacteremia↗
Post streptococcal acute glomerulonephritis secondary to sporadic Streptococcus equi infection.
Streptococcus equi subspecies zooepidemicus infection is rare in humans, but a well-known cause of pyogenic disease in cows and horses. S. zooepidemicus uncommonly causes post-strep glomerulonephritis (PSGN) in humans via epidemic outbreaks. We present a sporadic case of post S. zooepidemicus glomerulonephritis in a child most probably contracted from a horse. The 14-year-old girl presented with the typical signs of PSGN, with S. equi zooepidemicus isolated from a blood culture, together with a low C3 and raised anti-DNAse B. This is the first known report of a sporadic case of PSGN in a child caused by this organism.
Adolescent↗
Sequence analysis and characterization of phi O1205, a temperate bacteriophage infecting Streptococcus thermophilus CNRZ1205.
The complete nucleotide sequence of phi O1205, a temperate bacteriophage infecting Streptococcus thermophilus strain CNRZ1205, was determined. The phage genome has a unit length of 43,075 bp and appears to be packaged by the so-called headful mechanism. The genomic organization and structure of phi O1205 resemble those of several temperate lactococcal phages that display a life-cycle-specific organization, where ORFs believed to be involved in the lysogenic life-cycle are clustered and arranged in an orientation opposite to the ORFs supposedly involved in the lytic life-cycle. Database searches revealed putative functions for several identified ORFs and further indicated that phi O1205 is genetically related to a particular group of lactococcal phages. Three genes encoding the major structural proteins were identified on the phi O1205 genome. The phage attachment site attP, the bacterial attachment site attB, and the two phage/chromosome junctions attL and attR were identified and found to contain a 40 bp common core sequence.
Amino Acid Sequence↗
Puerperal group A Streptococcus infection: a case report.
BACKGROUND: Group A Streptococcus (GAS) sepsis is a rare event but carries a high risk of maternal mortality. CASE: A case of puerperal infection occurred with GAS. This patient had had an uneventful prenatal and intrapartum course. She was noted to have high, spiking fevers immediately postpartum, with minimal clinical symptoms. Her blood cultures were positive for GAS, most likely from a urinary tract infection. She was started on broad-coverage antibiotics and defervesced on postpartum day 4. She remained afebrile and was discharged on postpartum day 8. CONCLUSION: Patients with puerperal GAS sepsis commonly appear well clinically, with minor somatic complaints. GAS bacteremia should be suspected and promptly treated in women with high, spiking fevers early in the postpartum period. There are currently no guidelines on preventing vertical transmission. It is unclear how a patient with a previous history of GAS should be managed. Prophylactic use of penicillin during future labor may be warranted.
Adult↗
Clinical and microbiological characteristics of severe group A streptococcus infections and streptococcal toxic shock syndrome.
We have monitored all cases of invasive group A streptococcus (GAS) infection that have occurred at the New York Hospital (New York) since 1989. Five cases of GAS infection and shock were identified between 1990 and 1991, and an additional case was recently identified at an affiliated hospital. Five of the six patients met the case definition for streptococcal toxic shock syndrome (strep TSS). Three were bacteremic, and four had aggressive soft-tissue infections. Patients with shock, for whom the mortality was higher, had fewer underlying illnesses than did patients who had GAS bacteremia without shock. Although the M1 serotype and production of streptococcal pyrogenic exotoxin A were more common in patients with GAS infection and shock, several patients with strep TSS were infected with a nontypable strain of GAS that produced only streptococcal pyrogenic exotoxin B. In addition, we observed a distinctive early hemodynamic profile for patients with strep TSS that was unlike that for patients who had typical gram-negative septic shock; this profile was consistent with toxic cardiomyopathy (i.e., relatively low cardiac output, low-to-normal systemic vascular resistance, and striking reduction in ventricular performance.
Adult↗
[A case of bacteremic group A streptococcus infection with organ dysfunction following a minor skin abrasion].
A 20-year-old male was admitted to our hospital with the chief complaints of high fever and pain around his right hip joint. He had his right knee injured with a slight abrasion three weeks before. The diagnosis of suppurative lymphadenitis of inguen was made, and intravenous cefotiam was started. Despite these treatments his fever continued, general edema and dry cough appeared. Arterial blood gas showed severe hypoxia and chest X ray revealed marked cardiomegaly associated with ground-glass opacity over bilateral lower pulmonary fields. Slight renal insufficiency was also observed. On the fifth hospital day, the culture specimens of both blood and pus from the abrasion on admission yielded Streptococcus pyogenes. His condition was diagnosed as severe group A Streptococcus infection, then antibiotics were switched to intravenous administration of high dose aminobenzyl penicillin and clindamycin in combination with protease inhibitor, urinastatin. After these treatments, his condition improved and he was discharged from the hospital after one month. Group A Streptococcus may cause uncommon but life-threatening infection such as septicemia. Early recognition of the disease and prompt initiation of appropriate treatment may lead to successful outcome.
Adult↗
Population-based surveillance for postpartum invasive group a streptococcus infections, 1995-2000.
Estimates of disease burden and data on the sources of invasive postpartum group A streptococcus (GAS) infections will help guide public health action. Active, population-based surveillance was conducted in 9 regions from 1995 through 2000. A case of GAS infection was defined as isolation of GAS from a sterile site in a resident of a surveillance area who was pregnant or in the postpartum period. Census and live birth data were used to calculate rates. Eighty-seven cases of postpartum GAS infection (2.2% of 3957 invasive GAS infections) occurred at 3%-8% of hospitals annually. We estimate that 220 cases occurred annually in the United States. Two or more cases were noted during 6 months at 8 hospitals, during 1 year at 13 hospitals, and during 2 years at 16 hospitals. Cases due to identical emm types clustered more frequently than expected by chance. Although postpartum GAS infections are rare, the clustering of infections due to identical strains suggests that some invasive cases may have a common source and, therefore, may be preventable.
Adolescent↗
Group B streptococcus infection in infancy: 21-year experience.
In this hospital-based review, clinical presentations associated with Group B streptococcus (GBS) infections in children occurring between January 1980 and March 2000 were analyzed. Among the 25 infants with invasive group B streptococcal infections, 9 (36%) were early onset diseases (EOD), 12 (48%) were late onset diseases (LOD), and 4 (16%) occurred beyond the third month of life. Eight of the nine (89%) EOD cases manifested during the first day of life and three (33%) were premature births. Common presentations in GBS infection were fever (75%), poor activity (25%), respiratory distress (25%), lethargy (20%), and irritability (20%). Seizure occurred in 31% of infants with meningitis. Pneumonia (66%) and case-fatality rate (33.3%) were significantly higher in EOD than in LOD. Meningitis was the major manifestation (77%) of LOD and had severe sequelae in 40% of cases. Eight strains were assayed for antibiotic sensitivity and they were all susceptible to penicillin, ampicillin, cefotaxime, and vancomycin. The susceptibilities to erythromycin and clindamycin were 62% and 75%, respectively. Most of the strains from blood or cerebrospinal fluid were type III.
Humans↗
Pathogenesis of neonatal Streptococcus agalactiae infections.
Streptococcus agalactiae is an important human pathogen causing severe neonatal infections. During the course of infection, S. agalactiae colonizes and invades a number of different host compartments. Bacterial molecules including the polysaccharide capsule, the hemolysin, the C5a peptidase, the C-proteins, the hyaluronate lyase and a number of unknown bacterial components determine the interaction with host tissues. This review summarizes our current knowledge about these interactions.
Humans↗
The histologic fetoplacental inflammatory response in fatal perinatal group B-streptococcus infection.
OBJECTIVE: To determine the rate of histologic fetoplacental inflammation in fetuses and newborns with fatal perinatal Group B-Streptococcus (GBS) infection. STUDY DESIGN: Autopsy files (1990 to 2002) were searched for fetuses and newborns with GBS-positive post-mortem blood and/or lung cultures. The rate of histological fetoplacental inflammation in preterm (< 36 weeks gestational age) and term (> or =36 weeks) fetuses/infants was compared using chi(2) test. RESULTS: GBS infection was diagnosed in 4.9% (61/1236) of perinatal autopsies and was considered the exclusive cause of death in 58 cases (16 to 41 weeks gestation, median: 26 weeks). A total of 43 fetuses/infants (74%) were preterm, 24 (41%) were male and 33 (57%) stillborn. The histologic fetoplacental inflammatory response was age-dependent for the following variables: acute chorioamnionitis (seen in 67% of preterm vs 33% of term fetuses/infants, p < 0.05), multiple-vessel umbilical vasculitis (37 vs 7%, p < 0.05), funisitis (37 vs 13%, p < 0.05), and the presence of neutrophils in the gastrointestinal tract (35% vs none, p < 0.05). Neutrophils in the pulmonary airspaces (47 vs 33%) and pneumonia (16 vs 27%) were found with similar frequency in both groups. CONCLUSION: Histologic fetoplacental inflammation is a poor indicator of perinatal GBS infection; the sensitivity is 67% in preterm and 33% in term fetuses/newborns (overall sensitivity 59%). The higher rate of histologic inflammation in preterm fetuses/newborns suggests age-specific interactions between microorganism, host and placenta.
Chorioamnionitis↗