Clinical and epidemiological aspects of invasive Streptococcus pyogenes infections in Denmark during 2003 and 2004

  • Luca-Harari K.; van der Linden,M.; Staum-Kaltoft,M.; Hammerum,A.M.; Jasir,A. B
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Abstract

Active surveillance of invasive group A streptococcal (GAS) infections was conducted in Denmark during 2003 and 2004 as a part of the Strep-EURO initiative. The main objective was to improve understanding of the epidemiology of invasive GAS disease in Denmark. During the 2 years, 278 cases were reported, corresponding to a mean annual incidence of 2.6 cases per 100,000 inhabitants. The vast majority of isolates, 253 (91%), were from blood, with the remaining 25 (9%) being from cerebrospinal fluid, joints, or other normally sterile sites. The mean case fatality rate (CFR) was 20%, with the rate being higher in patients more than 70 years of age (36.5%). For streptococcal toxic shock syndrome (STSS) and necrotizing fasciitis the CFRs were 53% and 25%, respectively. Out of 16 T types recorded, three predominated: T28 (23%), T1 (22%), and the cluster T3/13/B3264 (14%). Among 29 different emm types, emm28 and emm1 accounted for 51% of strains, followed by emm3 (11%), emm89 (7%), and emm12 (5.5%). Low resistance rates were detected for macrolide-lincosamide-streptogramin B (MLS(B)) antibiotics (3%) and tetracycline (8%); two isolates exhibited coresistance to tetracycline and macrolides. Of nine pyrogenic exotoxin (superantigen) genes examined, speA and speC were identified in 58% and 40% of the strains, respectively; either of the genes was present in all strains causing STSS. Most strains harbored speG (99%). ssa was present in 14% of the isolates only. In Denmark, as in comparable countries, GAS invasive disease shows a sustained, high endemicity, with involvement of both established and emerging streptococcal emm and T types

Author-supplied keywords

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged,80 and over
  • Anti-Bacterial Agents
  • Antigens,Bacterial
  • Bacterial Outer Membrane Proteins
  • Carrier Proteins
  • Cerebrospinal Fluid
  • Child
  • Child,Preschool
  • DNA,Bacterial
  • Denmark
  • Disease
  • Drug Resistance,Bacterial
  • Endemic Diseases
  • Fasciitis,Necrotizing
  • Female
  • Genes,Bacterial
  • Humans
  • Incidence
  • Infant
  • Infant,Newborn
  • Joints
  • Macrolides
  • Male
  • Middle Aged
  • Patients
  • Sequence Analysis,DNA
  • Serotyping
  • Shock,Septic
  • Streptococcal Infections
  • Streptococcus
  • Streptococcus pyogenes
  • Sweden
  • Syndrome
  • blood
  • classification
  • drug effects
  • epidemiology
  • genetics
  • isolation & purification
  • microbiology
  • mortality
  • pharmacology
  • physiopathology

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Authors

  • B.; Ekelund Luca-Harari K.; van der Linden,M.; Staum-Kaltoft,M.; Hammerum,A.M.; Jasir,A.

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