Abstract
All 87 known cases of bacteraemia due toStreptococcus pyogenes (beta-haemolytic group A streptococci) occurring during the peak of a nationwide outbreak in Norway (population 4.2 million) between January and June 1988 were reviewed. Clinical features varied widely and appeared largely to be dependent on the patients' age. The case fatality rate ranged from 11 % in the age group under 30 years to 44 % in patients over 60 years. Clinical complications such as shock, severe renal or respiratory failure or serious local infection occurred particularly in 30-to 59-year old individuals. Shock was manifest in 32 % of the patients and carried a 68 % case fatality rate. Chronic heart disease in the elderly and pneumonia seemed to be associated with a fatal outcome. In the 25 patients (29 %) who died the disease showed a fulminant course, 80 % dying within 48 hours after admission. However, 56 % of the patients had experienced symptoms for more than two days before admission, suggesting that early diagnosis and treatment might possibly have prevented the development of a serious disease. This study revealed a wide spectrum of clinical manifestations in bacteraemia cases in a unique epidemiological situation caused largely by a single serotype ofStreptococcus pyogenes; 89 % of the 27 preserved bacteraemia strains carried the M-1 antigen. The observations call attention to the ability of these organisms to cause fulminant clinical illness, indicating a probable increase in both invasiveness and toxicity of group A streptococci responsible for the epidemic.
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References
Lancefield RC: A serologic differentiation of human and other groups of hemolytic streptococci. Journal of Experimental Medicine 1933, 57: 571–595.
Keefer CS, Ingelfinger FJ, Spink WW: Significance of hemolytic streptococci bacteremia: a study of 246 patients. Archives of Internal Medicine 1937, 60: 1084–1097.
Madsen ST: Scarlet fever and erysipelas in Norway during the last 100 years. Infection 1973, 1: 76–81.
Quinn RW: Epidemiology of group A streptococcal infections: their changing frequency and severity. Yale Journal of Biology and Medicine 1982, 55: 265–270.
Ispahani P, Donald FE, Aveline AJD:Streptococcus pyogenes bacteraemia: an old enemy subdued but not defeated. Journal of Infection 1988, 16: 37–46.
Francis J, Warren RE:Streptococcus pyogenes bacteraemia in Cambridge. A review of 67 episodes. Quarterly Journal of Medicine 1988, 256: 603–613.
Centers for Disease Control: Group A beta-hemolytic streptococcal bacteremia-Colorado 1989. Morbidity and Mortality Weekly Report 1990, 39: 3–6.
Bibler MR, Rouan GW: Cryptogenic group A streptococcal bacteremia: experience at an urban general hospital and review of the literature. Reviews of Infectious Diseases 1986, 8: 941–951.
Dan M, Maximora S, Siegman-Igra Y, Gutman R, Rotmensch HH: Varied presentations of sporadic group A streptococcal bacteremia: clinical experience and attempt at classification. Reviews of Infectious Diseases 1990, 12: 537–542.
Wong VK, Wright HT: Group A beta-hemolytic streptococci as a cause of bacteremia in children. American Journal of Diseases of Children 1988, 142: 831–833.
Christie CDC, Havens PL, Shapiro ED: Bacteremia with group A streptococci in childhood. American Journal of Diseases of Children 1988, 142: 559–561.
Dubey B, Francioli P, Poli S, Glauser MP: Septicemies a streptocoques du groupe A(S. pyogenes). Schweizerische Medizinische Wochenschrift 1983, 113:41–44.
Enzenberger R, Helm ER, Stille W: A-Streptokokken-Septikämien. Analyse von 18 Fällen bei Erwachsenen. Deutsche Medizinische Wochenschrift 1984, 109: 899–902.
Borg NL, Kish MA, Kauffman CA, Supena RB: Group A streptococcal bacteremia in intravenous drug abusers. American Journal of Medicine 1985, 76: 569–574.
Lentnek AL, Giger O, O'Rourke E: Group A betahemolytic streptococcal bacteremia and intravenous substance abuse. A growing clinical problem? Archives of Internal Medicine 1990, 150: 89–93.
Barnham M: Invasive streptococcal infections in the era before the acquired immune deficiency syndrome: a 10 years' compilation of patients with streptococcal bacteremia in North Yorkshire. Journal of Infection 1989, 18: 231–248.
Maclennan AC: Invasive streptococci. Lancet 1990, i: 109.
Begovac J, Gwajnicki B, Kuzmanovic N: Invasive streptococci. Lancet 1990, i: 109.
Cone LA, Woodard DR, Schlievert PM, Tomory GS: Clinical and bacteriologic observations of a toxic shock-like syndrome due toStreptococcus pyogenes. New England Journal of Medicine 1987, 317: 146–149.
Bartter T, Dascal A, Carroll K, Curley FJ: “Toxic strep syndrome”. A manifestation of group A streptococcal infection. Archives of Internal Medicine 1988, 148: 1421–1424.
Stevens DL, Tanner MH, Winship J, Swarts R, Ries KM, Schlievert PM, Kaplan EL: Severe group A streptococcal infections associated with a toxic shock-like syndrome and scarlet fever toxin A. New England Journal of Medicine 1989, 321: 1–7.
Conolly TJ, Pavelka DJ, Lanspa EF, Conolly TL: Toxic shock-like syndrome associated with necrotizingStreptococcus pyogenes infection. Henry Ford Hospital Medical Journal 1989, 37: 69–72.
Köhler W: Streptococcal toxic shock syndrome. Zentralblatt für Bakteriologie 1990, 272: 257–264.
Veasy LG, Wiedmeier SE, Orsmond GS, Ruttenberg HD, Boucek MM, Roth SJ, Tait VF, Thompson JA, Daly JA, Kaplan EL, Hill HR: Resurgence of acute rheumatic fever in the intermountain area of the United States. New England Journal of Medicine 1987, 316: 421–427.
Martin PR, Høiby EA: Streptokokkinfeksjoner i Norge 1987 og 1988. Oslo: National Institute of Public Health, Meldesystem for Infeksjonssykdommer 1988, 16: week 10.
Martin PR, Høiby EA: Streptococcal serogroup A epidemic in Norway 1987–1988. Scandinavian Journal of Infectious Diseases 1990, 22: 421–429.
Gaworzewska E, Colman G: Changes in the pattern of infection caused byStreptococcus pyogenes. Epidemiology and Infection 1988, 100: 257–269.
Holm S: Serious infections caused by group A streptococci. Stockholm: Statens Bakteriologiska Laboratorium, Epid Aktuellt 1988, 11: week 47.
Henrichsen J, Hoffman S, Rothgardt NP, Rønne T: Infection with group A streptococci. Copenhagen: Statens Seruminstitut, Epi-Nyt 1988, week 50.
Demers B, Simor AE, Vellend H, Low DE: Severe group A streptococcal disease, Toronto, Ontario. Canada Diseases Weekly Report 1990, 16–51: 259–260.
Schwartz B, Facklam RR, Breiman RF: Changing epidemiology of group A streptococcal infection in the USA. Lancet 1990, ii: 1167–1171.
Dudding B, Humphrey GB, Nesbit ME: Betahemolytic streptococcal septicemias in childhood leukemias. Pediatrics 1969, 43: 359–364.
Coulter JBS, Buchannon CR, Vellodi A, Hart CA, Sills JA: Group A streptococcal infection in the newborn. Lancet 1984, ii: 1473–1474.
Lehtonen O-P, Ruuskanen O, Kero P, Hollo O, Erkkola R, Salmi T: Group A streptococcal infection in the newborn. Lancet 1984, ii: 355–356.
Roberts FJ: Group A and group B β-hemolytic streptococcal bacteremia. Reviews of Infectious Diseases 1988, 10: 228–229.
Barnham M: Bacteraemia in streptococcal infections of the throat. Journal of Infection 1983, 7: 203–209.
Conner WT: FulminantStreptococcus pyogenes infection. British Medical Journal 1981, 282: 651.
Schlievert PM, Bettin KM, Watson DW: Reinterpretation of the Dick test: role of group A streptococcal pyrogenic exotoxin. Infection and Immunity 1979, 26: 467–472.
Murphy DJ: Group A streptococcal meningitis. Pediatrics 1983, 71: 1–5.
Molteni RA: Group A beta-hemolytic streptococcal pneumonia. Clinical course and complications of management. American Journal of Diseases of Children 1977, 131: 1366–1371.
Rimailho A, Riou B, Richard C, Auzepy P: Fulminant necrotizing fasciitis and nonsteroidal anti-inflammatory drugs. Journal of Infectious Diseases 1987, 155: 143–146.
Frankish PD, Mason GH, Allen PR, Milsom FP, Christmas TI: Acute streptococcal necrotising fasciitis. New Zealand Medical Journal 1988, 101: 625–626.
Hribalova V:Streptococcus pyogenes and toxic shock syndrome. Annals of Internal Medicine 1988, 108: 772.
Wannamaker LW: Streptococcal toxins. Reviews of Infectious Diseases 1983, 5, Supplement 4: 723–732.
Stegmayr B, Burman LÅ, Bäcklund U, Holm S, Settergren B, Svanström M: Två fall av allvarlig grupp A-streptokockinfektion. Läkartidningen 1989, 86: 3672–3675.
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Bucher, A., Martin, P.R., Høiby, E.A. et al. Spectrum of disease in bacteraemic patients during aStreptococcus pyogenes serotype M-1 epidemic in Norway in 1988. Eur. J. Clin. Microbiol. Infect. Dis. 11, 416–426 (1992). https://doi.org/10.1007/BF01961856
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DOI: https://doi.org/10.1007/BF01961856