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Lawrence SM, Wynn JL, Gordon SM. Neonatal bacteremia and sepsis. REMINGTON AND KLEIN'S INFECTIOUS DISEASES OF THE FETUS AND NEWBORN INFANT 2025:183-232.e25. [DOI: 10.1016/b978-0-323-79525-8.00015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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Shen X, Liang H, Wu G, Chen M, Li J. A Case Report of Streptococcus Dysgalactiae Toxic Shock Syndrome Complicated with Symmetric Peripheral Gangrene. Infect Drug Resist 2023; 16:5977-5983. [PMID: 37705513 PMCID: PMC10496922 DOI: 10.2147/idr.s426930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/05/2023] [Indexed: 09/15/2023] Open
Abstract
Streptococcus dysgalactiae subspecies equlsimilis (SDSE) is considered an important bacterial pathogen, and attention has also increased with the increasing number of invasive SDSE infections. Here, we report a patient with S. dysgalactiae toxic shock syndrome complicated by symmetrical peripheral gangrene (SPG). Despite surviving active treatment, amputation severely impacts the quality of life of patients. Therefore, we should pay attention to the early treatment of SDSE infection and the prevention and treatment of related complications.
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Affiliation(s)
- Xiaoqing Shen
- Department of Critical Care Medicine, Zhongshan People’s Hospital, Zhongshan, People’s Republic of China
| | - Hongkai Liang
- Department of Critical Care Medicine, Zhongshan People’s Hospital, Zhongshan, People’s Republic of China
| | - Guishen Wu
- Department of Critical Care Medicine, Zhongshan People’s Hospital, Zhongshan, People’s Republic of China
| | - Miaolian Chen
- Department of Critical Care Medicine, Zhongshan People’s Hospital, Zhongshan, People’s Republic of China
| | - Jianwei Li
- Department of Critical Care Medicine, Zhongshan People’s Hospital, Zhongshan, People’s Republic of China
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Nevanlinna V, Huttunen R, Aittoniemi J, Luukkaala T, Rantala S. Incidence, seasonal pattern, and clinical manifestations of Streptococcus dysgalactiae subspecies equisimilis bacteremia; a population-based study. Eur J Clin Microbiol Infect Dis 2023:10.1007/s10096-023-04607-8. [PMID: 37119347 DOI: 10.1007/s10096-023-04607-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 04/19/2023] [Indexed: 05/01/2023]
Abstract
Streptococcus dysgalactiae subspecies equisimilis (SDSE) is a human pathogen causing severe invasive infections. Population-based studies on SDSE bacteremia are limited. The purpose of this study was to investigate the incidence, seasonal pattern, clinical manifestations, and recurrence of SDSE bacteraemia. Records regarding patients aged ≥ 18 years with SDSE bacteremia in the Pirkanmaa health district in August 2015 to July 2018 were retrospectively reviewed. A total of 230 SDSE bacteremia episodes were identified, with 217 episodes (involving 211 patients) available for analysis. The mean annual incidence rate of SDSE bacteremia was 16.9/100 000 inhabitants. Most episodes (33%) were detected in the summer (June to August) (p = 0.058). Episodes with bacteremic cellulitis were statistically significantly more common during the summer compared with other seasons (p = 0.008). Cellulitis was the most common presenting clinical manifestation of SDSE bacteremia (68% of all episodes). Risk factors of recurring bacteremia were chronic eczema and/or skin erosion (OR 3.96 [95% CI 1.11-14.1]), heart disease (OR 3.56 [95% CI 1.22-10.4]), diabetes (OR 3.77 [95% CI 1.35-10.5]) and a history of cellulitis. We found a remarkably high incidence of SDSE bacteraemia in the Pirkanmaa health district. Bacteraemic cellulitis, which was the predominant clinical manifestation is more often occurred in the summer. Risk factors of recurring SDSE bacteremia were a history of cellulitis, chronic eczema or skin erosion, diabetes, and heart disease.
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Affiliation(s)
- Viivi Nevanlinna
- Department of Internal Medicine, Tampere University Hospital, Elämänaukio, Kuntokatu 2, 33520, Tampere, Finland.
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
| | - Reetta Huttunen
- Department of Internal Medicine, Tampere University Hospital, Elämänaukio, Kuntokatu 2, 33520, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | | | - Tiina Luukkaala
- Research, Development and Innovation Center, Tampere University Hospital, Tampere, Finland
- Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Sari Rantala
- Department of Internal Medicine, Tampere University Hospital, Elämänaukio, Kuntokatu 2, 33520, Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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Ghazanfar H, Qureshi Z, Kalangi H, Ata S, Jyala A, Perez EA. Recurrent group G Streptococcus bacteremia: A case report and literature review. Clin Case Rep 2022; 10:e6162. [PMID: 35957769 PMCID: PMC9359971 DOI: 10.1002/ccr3.6162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/28/2022] [Indexed: 11/15/2022] Open
Abstract
Streptococci group G is an important opportunistic pathogen and causes a wide variety of infections, including pharyngitis, skin and soft tissue infections, bacteremia, endocarditis, septic arthritis, intra-abdominal infections, meningitis, and streptococcal toxic shock-like syndrome. As a result, we discuss an interesting case of recurrent group G streptococcal bacteremia in a 68-year-old man presenting with altered mental status. We also discuss the risk factors, etiology, pathophysiology, diagnosis, and treatment of group G streptococcal bacteremia.
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Affiliation(s)
- Haider Ghazanfar
- BronxCare Health System, Internal Medicine 1650 Selwyn AvenueBronxNew YorkUSA
| | - Zaheer Qureshi
- BronxCare Health System, Internal Medicine 1650 Selwyn AvenueBronxNew YorkUSA
| | - Harika Kalangi
- BronxCare Health System, Internal Medicine 1650 Selwyn AvenueBronxNew YorkUSA
| | - Subhan Ata
- BronxCare Health System, Internal Medicine 1650 Selwyn AvenueBronxNew YorkUSA
| | - Abhilasha Jyala
- BronxCare Health System, Internal Medicine 1650 Selwyn AvenueBronxNew YorkUSA
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Sunagawa K, Shirafuji T, Sun G, Arai R, Azuma H, Miyoshi-Akiyama T, Katano H. Intra-familial transmission of Streptococcus dysgalactiae subsp. equisimilis (SDSE): A first case report and review of the literature. J Infect Chemother 2022; 28:819-822. [PMID: 35115237 DOI: 10.1016/j.jiac.2022.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/02/2022] [Accepted: 01/17/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Concern about Streptococcus dysgalactiae infections has been increasing worldwide, and many cases of invasive infections have been reported. Streptococcus dysgalactiae has two main subspecies: S. dysgalactiae subsp. equisimilis (SDSE) and S. dysgalactiae subsp. dysgalactiae (SDSD). The epidemiology of invasive SDSE infections is not well understood, and the exact numbers of human SDSE infections are not known because standard laboratories are not able to identify Lancefield group C streptococci (GCS) or group G streptococci (GGS) to the species level. SDSE is often present in skin lesions, and sites of SDSE colonization and focal SDSE infections serve as the principal reservoirs for the transmission of skin and soft-tissue infections. Although the person-to-person transmission of S. pyogenes infections has been reported, the intra-familial transmission of SDSE has not been reported. CASE PRESENTATION We report two cases of cellulitis with bacteremia in a family. A 72-year-old female with cellulitis in her right lower extremity was hospitalized, and a 104-year-old male relative was hospitalized with cellulitis 2 days later. Two strains of Streptococcus dysgalactiae subsp. equisimilis were isolated from the blood of the patients. Single nucleotide polymorphism analysis of the bacterial genomes suggested that the two strains had the same origin. This is the first case report about the intra-familial transmission of Streptococcus dysgalactiae subsp. equisimilis. CONCLUSIONS This is the first case report about the intra-familial transmission of Streptococcus dysgalactiae subsp. equisimilis.
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Affiliation(s)
- Keishin Sunagawa
- Clinical Pathology and Laboratory Medicine, Anatomic Pathology, Saitama Cooperative Hospital, Saitama, Japan; Department of Pathology, National Institute of Infectious Diseases, Toyama, Shinjuku, Tokyo, Japan.
| | | | - Guodong Sun
- Internal Medicine, Saitama Cooperative Hospital, Saitama, Japan
| | - Rina Arai
- Clinical Pathology and Laboratory Medicine, Saitama Cooperative Hospital, Saitama, Japan
| | - Hiroki Azuma
- Clinical Pathology and Laboratory Medicine, Saitama Cooperative Hospital, Saitama, Japan
| | - Tohru Miyoshi-Akiyama
- Pathogenic Microbe Laboratory, Research Institute, National Center for Global Health and Medicine, Toyama, Shinjuku, Tokyo, Japan
| | - Harutaka Katano
- Department of Pathology, National Institute of Infectious Diseases, Toyama, Shinjuku, Tokyo, Japan
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Baracco GJ. Infections Caused by Group C and G Streptococcus ( Streptococcus dysgalactiae subsp. equisimilis and Others): Epidemiological and Clinical Aspects. Microbiol Spectr 2019; 7:10.1128/microbiolspec.gpp3-0016-2018. [PMID: 30977463 PMCID: PMC11590429 DOI: 10.1128/microbiolspec.gpp3-0016-2018] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Indexed: 01/27/2023] Open
Abstract
Streptococci carrying serogroup C and G antigens, and in particular, Streptococcus dysgalactiae subsp. equisimilis (SDSE), are emerging human pathogens that are increasingly isolated from patients with a myriad of infections that range from mundane to life-threatening. SDSE is microbiologically similar to Streptococcus pyogenes. These streptococci frequently cause infections of the throat and skin and soft tissues. Moreover, they may invade the bloodstream and disseminate widely to many deep tissue sites, including the endocardium. Life-threatening invasive infections due to SDSE, including the streptococcal toxic shock syndrome, occur most frequently in patients with severe underlying medical diseases. Treatment with penicillin is adequate under most circumstances, but treatment failure occurs. SDSE may also be resistant to other antibiotic classes including tetracyclines, macrolides, and clindamycin. Most human infections caused by groups C and G streptococci are transmitted from person to person, but infections due to Streptococcus equi subsp. zooepidemicus (and, rarely, to S. equi subsp. equi) are zoonoses. Transmission of these latter species occurs by animal contact or by contamination of food products and has been associated with the development of poststreptococcal glomerulonephritis. Members of the Streptococcus anginosus group, usually classified with the viridans group of streptococci, are associated with a variety of pyogenic infections.
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Affiliation(s)
- Gio J Baracco
- University of Miami Miller School of Medicine and Miami Veterans Affairs Healthcare System, Miami, FL 33125
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Pocinho RM, Antunes L, Pires P, Baptista I. Multifocal septic arthritis, gluteal abscess and spondylodiscitis by Streptococcus dysgalactiae subspecies equisimilis after an intramuscular injection. BMJ Case Rep 2017; 2017:bcr-2017-220336. [PMID: 28724597 PMCID: PMC5535059 DOI: 10.1136/bcr-2017-220336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2017] [Indexed: 11/04/2022] Open
Abstract
We present the case of a 63-year-old man, admitted for hand cellulitis and acute kidney injury. A Streptococcus dysgalactiae subsp equisimilis (SDSE) was isolated in blood cultures and despite directed intravenous antibiotherapy, the patient evolved unfavourably, with dorsolumbar spondylodiscitis, multifocal septic arthritis and abscesses. CT also showed densification of the gluteal muscles, multiple air bubbles in the psoas, paraspinal muscles and spinal canal that were associated with an intramuscular injection administered 1 week earlier for a backache. After escalation of the antibiotherapy and intensive supportive measures, the patient showed improvement and was discharged after 8 weeks of antibiotherapy.The incidence of invasive SDSE infections has been growing, especially in immunosupressed patients. In this case, despite no predisposing factor identified, it evolved to severe sepsis. The intramuscular injection, a trivialised but not harmless procedure, was the assumed port of entry, as previously described in another case report.
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Affiliation(s)
- Rita Marques Pocinho
- Department of Medicina 1.2, Hospital de São José, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Liliana Antunes
- Department of Medicina 1.2, Hospital de São José, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Pedro Pires
- Department of Medicina 1.2, Hospital de São José, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Isabel Baptista
- Department of Medicina 1.2, Hospital de São José, Centro Hospitalar Lisboa Central, Lisboa, Portugal
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Zheng PX, Chan YC, Chiou CS, Hsieh CL, Chiang-Ni C, Wu JJ. Highly prevalent emmSTG840.0 and emmSTC839.0 types of erythromycin non-susceptible group G Streptococcus isolated from bacteremia in southern Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 50:831-838. [PMID: 28711431 DOI: 10.1016/j.jmii.2016.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 12/09/2016] [Accepted: 12/27/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND/PURPOSE Group G Streptococcus (GGS) infections in human have increased. Treatment relied on antibiotic therapy, including erythromycin. However, information regarding the dominant strains and erythromycin susceptibility in GGS bacteremia is limited. METHODS A total of 134 GGS were isolated from patients with bacteremia in a university hospital of southern Taiwan during 1993-2010. The erythromycin susceptibility was determined by disc diffusion and agar dilution assays. The bacterial species was determined by MALDI-TOF. The presence of erythromycin-resistant genes and emm types were determined by polymerase chain reaction and sequence. The clonal spreading was analyzed by pulsed-field gel electrophoresis with SmaI or SgrAI digestion. RESULTS The annual erythromycin non-susceptible rate varied, with an average of 40.3%. All erythromycin non-susceptible strains belonged to the Streptococcus dysgalactiae. No erythromycin non-susceptible strains belong to the anginosus group. The most prevalent erythromycin-resistant gene was mefA (57.4%), followed by ermB (37%), and ermA (3.7%). The N terminal hyper variable region of emm was sequenced to determine the emm type, and only S. dysgalactiae had the emm gene. The most prevalent emm types were emmSTG840.0 (17.2%), emmSTG485.0 (10.4%), and emmSTC839.0 (9.0%). 73% and 47% of the strains with only mefA and ermB belonged to emmSTG840.0 and emmSTC839.0 types, respectively. Pulsed-field gel electrophoresis showed that different clones of emmSTG840.0 and emmSTC839.0 strains were spread in this region during the 18 years of surveillance. CONCLUSION Our data indicate that there were dominant emm types with erythromycin non-susceptibility in S. dysgalactiae isolated from bacteremia in Taiwan, and thus constant surveillance is warranted.
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Affiliation(s)
- Po-Xing Zheng
- Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan, Taiwan
| | - Yuen-Chi Chan
- Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Shun Chiou
- Center for Research, Diagnostics and Vaccine Development, Centers for Disease Control, Taichung, Taiwan
| | - Cheng-Lu Hsieh
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chuan Chiang-Ni
- Department of Microbiology and Immunology, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Jiunn-Jong Wu
- Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan, Taiwan; Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Biotechnology and Laboratory Science in Medicine, School of Biomedical Science and Engineering, National Yang-Ming University, Taipei, Taiwan.
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Acute Bacterial Meningitis and Systemic Abscesses due to Streptococcus dysgalactiae subsp. equisimilis Infection. Case Rep Infect Dis 2017; 2017:8645859. [PMID: 28512590 PMCID: PMC5420411 DOI: 10.1155/2017/8645859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 04/11/2017] [Indexed: 12/03/2022] Open
Abstract
Disseminated abscesses due to group G β-hemolytic Streptococcus dysgalactiae were observed in a 57-year-old cirrhotic patient with the skin being the putative way of entry for the pathogen. S. dysgalactiae is a rare agent in human infections responsible for acute pyogenic meningitis. The mortality rate associated with S. dysgalactiae bacteraemia and meningitis may be as high as 50%, particularly in the presence of endocarditis or brain abscesses. In our patient, main sites of infections were meningitis and ventriculitis, spondylodiscitis, septic arthritis, and soft-tissue infections. In contrast, no endocarditis was evidenced. Cirrhosis-related immune suppression was considered as a pathophysiological cofactor for the condition. Fortunately, clinical status improved after long-term (3 months) antimicrobial therapy.
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10
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Young K, Luni FK, Yoon Y. Toxic Shock Syndrome: An Unusual Organism. Am J Med Sci 2016; 352:86-90. [DOI: 10.1016/j.amjms.2016.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 05/28/2015] [Indexed: 10/21/2022]
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Siemens N, Kittang BR, Chakrakodi B, Oppegaard O, Johansson L, Bruun T, Mylvaganam H, Svensson M, Skrede S, Norrby-Teglund A. Increased cytotoxicity and streptolysin O activity in group G streptococcal strains causing invasive tissue infections. Sci Rep 2015; 5:16945. [PMID: 26601609 PMCID: PMC4658506 DOI: 10.1038/srep16945] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 10/22/2015] [Indexed: 11/09/2022] Open
Abstract
Streptococcus dysgalactiae subsp. equisimilis (SDSE) has emerged as an important cause of severe skin and soft tissue infections, but little is known of the pathogenic mechanisms underlying tissue pathology. Patient samples and a collection of invasive and non-invasive group G SDSE strains (n = 69) were analyzed with respect to virulence factor expression and cytotoxic or inflammatory effects on human cells and 3D skin tissue models. SDSE strains efficiently infected the 3D-skin model and severe tissue pathology, inflammatory responses and altered production of host structural framework proteins associated with epithelial barrier integrity were evident already at 8 hours post-infection. Invasive strains were significantly more cytotoxic towards keratinocytes and expressed higher Streptokinase and Streptolysin O (SLO) activities, as compared to non-invasive strains. The opposite was true for Streptolysin S (SLS). Fractionation and proteomic analysis of the cytotoxic fractions implicated SLO as a factor likely contributing to the keratinocyte cytotoxicity and tissue pathology. Analyses of patient tissue biopsies revealed massive bacterial load, high expression of slo, as well as immune cell infiltration and pro-inflammatory markers. Our findings suggest the contribution of SLO to epithelial cytotoxicity and tissue pathology in SDSE tissue infections.
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Affiliation(s)
- Nikolai Siemens
- Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Bård R Kittang
- Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Bhavya Chakrakodi
- Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Oddvar Oppegaard
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Linda Johansson
- Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Trond Bruun
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Haima Mylvaganam
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | | | - Mattias Svensson
- Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Steiner Skrede
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Medicine, Haukeland University Hospital, Bergen, Norway
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Clinical evaluation of commercial nucleic acid amplification tests in patients with suspected sepsis. BMC Infect Dis 2015; 15:199. [PMID: 25928122 PMCID: PMC4419503 DOI: 10.1186/s12879-015-0938-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 04/22/2015] [Indexed: 12/15/2022] Open
Abstract
Background Sepsis is a serious medical condition requiring timely administered, appropriate antibiotic therapy. Blood culture is regarded as the gold standard for aetiological diagnosis of sepsis, but it suffers from low sensitivity and long turnaround time. Thus, nucleic acid amplification tests (NAATs) have emerged to shorten the time to identification of causative microbes. The aim of the present study was to evaluate the clinical utility in everyday practice in the emergency department of two commercial NAATs in patients suspected with sepsis. Methods During a six-week period, blood samples were collected consecutively from all adult patients admitted to the general emergency department for suspicion of a community-onset sepsis and treated with intravenous antibiotics. Along with conventional blood cultures, multiplex PCR (Magicplex™) was performed on whole blood specimens whereas portions from blood culture bottles were used for analysis by microarray-based assay (Prove-it™). The aetiological significance of identified organisms was determined by two infectious disease physicians based on clinical presentation and expected pathogenicity. Results Among 382 episodes of suspected sepsis, clinically relevant microbes were detected by blood culture in 42 episodes (11%), by multiplex PCR in 37 episodes (9.7%), and by microarray in 32 episodes (8.4%). Although moderate agreement with blood culture (kappa 0.50), the multiplex PCR added diagnostic value by timely detection of 15 clinically relevant findings in blood culture-negative specimens. Results of the microarray corresponded very well to those of blood culture (kappa 0.90), but were available just marginally prior to blood culture results. Conclusions The use of NAATs on whole blood specimens in adjunct to current culture-based methods provides a clinical add-on value by allowing for detection of organisms missed by blood culture. However, the aetiological significance of findings detected by NAATs should be interpreted with caution as the high analytical sensitivity may add findings that do not necessarily corroborate with the clinical diagnosis. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-0938-4) contains supplementary material, which is available to authorized users.
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Su P, Zheng Z, Pang Y, Xue Z, Gou M, Han Y, Liu G, Zan Q, Li Q. Preparation, identfication, and activity assay of lamprey (lampetra japonica) natural intelectins. J Immunoassay Immunochem 2014; 36:368-78. [PMID: 25275839 DOI: 10.1080/15321819.2014.955583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Intelectins play an important role in innate immune response. In a previous study, lamprey inteletins purified by galactose-Sepharose were inactive and insoluble. Herein, we provided a simple and effective method to purify natural intelectins from the serum of lamprey (Lethenteron japonicum) using proteinG agarose. SDS-PAGE, two-dimensional polyacrylamide gel electrophoresis (2D-PAGE), and mass spectrometry (MS) were used to analyze the purified proteins. The purified proteins were identified to be lamprey serum lectin and intelectinB. The activity analysis results indicated that the proteins had certain extent agglutination activity. The effective method will be useful to study their immune functions and molecular mechanisms.
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Affiliation(s)
- Peng Su
- a College of Life Science , Liaoning Normal University , Dalian , China
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14
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Streptococcus dysgalactiae subsp. equisimilis bacteremia: an emerging infection. Eur J Clin Microbiol Infect Dis 2014; 33:1303-10. [PMID: 24682845 DOI: 10.1007/s10096-014-2092-0] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 03/10/2014] [Indexed: 10/25/2022]
Abstract
The importance of group C and G Streptococcus dysgalactiae subspecies equisimilis (S. dysgalactiae subsp. equisimilis) as a significant pathogen has recently been better recognized. S. dysgalactiae subsp. equisimilis disease can range in severity from milder skin and soft-tissue conditions such as wound infection, erysipelas, and cellulitis, to life-threatening necrotizing fasciitis and streptococcal toxic shock syndrome, thus sharing the clinical picture with S. pyogenes. The most common clinical manifestation of bacteremia is cellulitis. An increase in the incidence of S. dysgalactiae subsp. equisimilis bacteremia has been recognized. Invasive forms of this infection are most commonly found in elderly patients with underlying comorbidities and skin breakdown. The case fatality in bacteremia has been reported to be 15-18%. In this review, the epidemiology, clinical characteristics, and emm types of S. dysgalactiae subsp. equisimilis bacteremia are summarized.
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15
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Rantala S, Tuohinen S. Two cases of cardiac device-related endocarditis due to Streptococcus dysgalactiae subsp. equisimilis (group C or G streptococci). BMC Infect Dis 2014; 14:174. [PMID: 24678588 PMCID: PMC3976168 DOI: 10.1186/1471-2334-14-174] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 03/27/2014] [Indexed: 11/17/2022] Open
Abstract
Background Cardiac device-related endocarditis is a very rare clinical manifestation of S. dysgalactiae subsp. equisimilis disease. This pathogen is a common cause of cellulitis. We here report two cases of cardiac device-related endocarditis due to Streptococcus dysgalactiae subsp. equisimilis. Blood cultures yielded this pathogen and both patients had recurrent bacteremia. Transthoracic and transesophageal echocardiography revealed lead vegetations. This is a new description of this pathogen to cause cardiac device-related endocarditis. Case presentation The first case is a 79-year-old finnish woman who received a dual-chamber pacemaker for intermittent complete heart block in April 2011. She had three episodes of S. dysgalactiae subsp. equisimilis bacteremia. During first episode she had arthritis of glenohumeral joint. Focus was unknown in the second and third bacteremic episodes. During third bacteremic episode transesophageal echocardiography (TEE) revealed lead vegetation. Patient underwent successful complete system removal. She was treated with benzylpenicillin four million IU six times a day for four weeks intravenously. The second case is a 92-year-old finnish man. A dual-chamber pacemaker was implanted on June 2012 due to total heart block. He had recurrent S. dysgalactiae subsp. equisimilis bacteremia with cellulitis. During the second bacteremic episode transthoracic echocardiography (TTE) was performed because of persistent fever. Echocardiography revealed lead vegetation. Abdominal CT revealed also an abscess in the psoas region. This elderly patient was very fragile, and the pacemaker system was not extracted. Therapy was continued with benzylpenicillin four million IU six times a day for six weeks intravenously and thereafter suppressive treatment with amoksisillin 500 mg three times a day was initiated. Conclusion Streptococcus dysgalactiae subsp. equisimilis (group C and G streptococci) seldom cause cardiac device endocarditis. Both patients had recurrent bacteremia of S. dysgalactiae subsp. equisimilis and echocardiography revealed cardiac device-related endocarditis. These cases emphasize the importance of considering endocarditis in elderly persons having cardiac devices together with the presence of unexplained bacteremia, fever without focus or persistent fever.
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Affiliation(s)
- Sari Rantala
- Department of Internal Medicine, Tampere University Hospital, P,O, Box 2000, FIN-33521 Tampere, Finland.
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Tsai CT, Chi CY, Ho CM, Lin PC, Chou CH, Wang JH, Wang JH, Lin HC, Tien N, Lin KH, Ho MW, Lu JJ. Correlation of virulence genes to clinical manifestations and outcome in patients with Streptococcus dysgalactiae subspecies equisimilis bacteremia. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2013; 47:462-8. [PMID: 24210866 DOI: 10.1016/j.jmii.2013.08.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Revised: 08/18/2013] [Accepted: 08/30/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND/PURPOSE Streptococcus dysgalactiae subsp. equisimilis (SDSE) is increasingly recognized as a human pathogen responsible for invasive infection and streptococcal toxic shock syndrome (STSS). The pathogen possesses virulence genes that resemble those found in Streptococcus pyogenes (GAS). We analyzed the association between these specific toxic genes, clinical presentations, and outcome in patients with SDSE infections. METHODS Patients (older than 18 years) with community-acquired invasive bacteremia caused by SDSE bacteremia who were undergoing treatment at China Medical University Hospital from June 2007 to December 2010 were included in this study. Multiplex polymerase chain reaction was performed to identify virulence genes of the SDSE isolates. Demographic data, clinical presentations, and outcome in patients with SDSE infections were reviewed and analyzed. RESULTS Forty patients with 41 episodes of SDSE bacteremia were reviewed. The median age of the patients with SDSE infection was 69.7 years; 55% were female and 78% had underlying diseases. Malignancy (13, 33%) and diabetes mellitus (13, 33%) were the most common comorbidities. The 30-day mortality rate was 12%. Compared with the survivors, the non-survivors had a higher rate of diabetes mellitus (80% vs. 26%), liver cirrhosis (60% vs.11%), shock (60% vs.17%), STSS (60% vs. 8%), and a high Pittsburgh bacteremia score >4 (40% vs. 6%). Most isolates had scpA, ska, saga, and slo genes, whereas speC, speG, speH, speI, speK, smez, and ssa genes were not detected. speA gene was identified only in one patient with STSS (1/6, 17%). All isolates were susceptible to penicillin, cefotaxime, levofloxacin, moxifloxacin, vancomycin, and linezolid. CONCLUSION In invasive SDSE infections, most isolates carry putative virulence genes, such as scpA, ska, saga, and slo. Clinical SDSE isolates in Taiwan remain susceptible to penicillin cefotaxime, and levofloxacin.
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Affiliation(s)
- Chia-Ta Tsai
- Division of Infectious Disease, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Yu Chi
- Division of Infectious Disease, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Cheng-Mao Ho
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan; Department of Laboratory Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Po-Chang Lin
- Division of Infectious Disease, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Hui Chou
- Division of Infectious Disease, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Jen-Hsien Wang
- Division of Infectious Disease, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Jui-Hsing Wang
- Division of Infectious Disease, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Hsiao-Chuan Lin
- Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan
| | - Ni Tien
- Department of Laboratory Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Kuo-Hsi Lin
- Division of Infectious Diseases, Department of Health, Chang-Hua Hospital, Chang-Hua, Taiwan
| | - Mao-Wang Ho
- Division of Infectious Disease, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
| | - Jang-Jih Lu
- Department of Laboratory Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Department of Medical Biotechnology and Laboratory Science, Chang Gung University, Kweishan, Taoyuan, Taiwan.
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17
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Alcívar-Vásquez JM, Giráldez-Gallego A, Sousa-Martín JM, Lepe-Jiménez JA. [Bacteraemia due to Streptococcus equi spp. zooepidemicus in a liver transplant recipient]. Enferm Infecc Microbiol Clin 2013; 32:332-3. [PMID: 24054044 DOI: 10.1016/j.eimc.2013.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 06/18/2013] [Accepted: 07/01/2013] [Indexed: 11/26/2022]
Affiliation(s)
| | - Alvaro Giráldez-Gallego
- Unidad de Gestión Clínica de Aparato Digestivo, Hospitales Universitarios Virgen del Rocío, Sevilla, España.
| | - José Manuel Sousa-Martín
- Unidad de Gestión Clínica de Aparato Digestivo, Hospitales Universitarios Virgen del Rocío, Sevilla, España
| | - José Antonio Lepe-Jiménez
- Unidad de Gestión Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospitales Universitarios Virgen del Rocío, Sevilla, España
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18
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Streptococcus dysgalactiae Subspecies Equisimilis; An Agent Rarely Encountered in the Etiology of Septic Arthritis. Jundishapur J Microbiol 2013. [DOI: 10.5812/jjm.9175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Kugu S, Sevim MS, Kaymak NZ, Erdogan G, Kandemir B, Dogan OK. Exogenous group G Streptococcus endophthalmitis following intravitreal ranibizumab injection. Clin Ophthalmol 2012; 6:1399-402. [PMID: 22969285 PMCID: PMC3437953 DOI: 10.2147/opth.s31721] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
We report a case of group G Streptococcus endophthalmitis following an intravitreal ranibizumab injection for a choroidal neovascular membrane. Pars plana vitrectomy was applied for endophthalmitis and group G Streptococcus cultures were isolated in the vitreous samples taken from the patient. Twenty-four hours following pars plana vitrectomy the patient underwent myocardial infarction and cardiac arrest. To our knowledge this is the first reported case of group G Streptococcus endophthalmitis following an intravitreal injection.
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Affiliation(s)
- Suleyman Kugu
- Lutfi Kırdar Kartal Training and Research Hospital, Eye Clinic, Istanbul
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20
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Two cases of osteomyelitis due to group G streptococcus. Can J Infect Dis 2012; 1:61-3. [PMID: 22553442 DOI: 10.1155/1990/989357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/1990] [Accepted: 05/07/1990] [Indexed: 11/17/2022] Open
Abstract
Two cases of group G streptococcal osteomyelitis in adults are reported, one of the patients being an otherwise healthy individual. Both cases were successfully treated with parenteral aqueous penicillin G. Only one case of group G streptococcal osteomyelitis has been described previously in the literature; this was in an intravenous drug abuser.
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21
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Steckelberg RC, Wang AT, Wilson W. Infective endophthalmitis due to Group G Streptococcal infection in a patient with metastatic ovarian carcinoma. BMJ Case Rep 2011; 2011:bcr.07.2011.4526. [PMID: 22678738 DOI: 10.1136/bcr.07.2011.4526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A woman with stage IV metastatic papillary serous ovarian cancer presented with fever, altered mental status, difficulty with vision and right knee pain. On physical examination, she had pain on palpation and with flexion and extension of the left knee and bilateral purulent, bilateral conjunctivitis. Vitreal ultrasound revealed dense opacities within the posterior vitreous detachment bilaterally. Aspiration of both the left knee and vitreous fluid from the left eye revealed Group G Streptococcus (GGS). Later blood cultures also revealed GGS, susceptible to both vancomycin and cephalosporins. She was started on broad-spectrum antibiotics. The patient was diagnosed with bilateral GGS endophthalmitis and was treated with vitreous injections of vancomycin and ceftazidime. The patient improved significantly after antibiotic treatment though vision was not restored. Given the loss of vision and recurrent metastatic ovarian cancer, she opted to pursue palliative care and passed away within the year.
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22
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Suemori S, Sawada A, Komori S, Mochizuki K, Ohkusu K, Takemura H. Case of endogenous endophthalmitis caused by Streptococcus equisimilis. Clin Ophthalmol 2010; 4:917-8. [PMID: 20823933 PMCID: PMC2925454 DOI: 10.2147/opth.s10900] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Indexed: 11/23/2022] Open
Abstract
We report a rare case of endogenous endophthalmitis caused by Streptococcus equisimilis. A 74-year-old woman with endocarditis developed endogenous endophthalmitis. The patient underwent emergency mitral valvuloplasty, and intravitreal and subconjunctival injections of vancomycin and meropenem. After the surgery, she was treated with topical antibiotics, ointment, intravenous gentamicin and intravenous penicillin G potassium. The causative organism was identified as S. equisimilis. S. equisimilis should be considered as a pathogen that can cause severe endogenous endophthalmitis.
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Affiliation(s)
- Shinsuke Suemori
- Department of Ophthalmology. University Graduate School of Medicine, Gifu, Japan
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23
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Rantala S, Vuopio-Varkila J, Vuento R, Huhtala H, Syrjänen J. Predictors of mortality in beta-hemolytic streptococcal bacteremia: a population-based study. J Infect 2009; 58:266-72. [PMID: 19261333 DOI: 10.1016/j.jinf.2009.01.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2008] [Revised: 01/11/2009] [Accepted: 01/19/2009] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Several factors associated with mortality in Lancefield group A beta-hemolytic streptococcal bacteremia have been described in population-based surveillance studies, whereas such reports on group B, C, and G streptococcal are scant. METHODS In this population-based study all 314 episodes of beta-hemolytic streptococcal bacteremia in adult patients in the Pirkanmaa area, Finland, during the 10-year period 1995-2004 were retrospectively reviewed. RESULTS The 30-day case-fatality rate was 13%, being highest in group C (22%); in group A it was 15%, in group B 7%, and in group G 15%. Confusion, unconsciousness and dyspnea as the first sign or symptom were associated with increased case-fatality, while fever seemed to be a protecting factor for death. Alcoholism and ultimately or rapidly fatal underlying disease were significantly associated with increased case-fatality. Among infections of the skin and soft-tissues, necrotizing fasciitis had the highest risk of death (38%), while patients with cellulitis had a case-fatality of 8%. A history of previous cellulitis seemed to protect against death (case-fatality of 3% as compared to 16% among those without such a history (p=0.014)). CONCLUSION A history of previous cellulitis seemed to be a protecting factor against death. Fever was also associated with a good prognosis.
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Affiliation(s)
- Sari Rantala
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.
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24
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Goh ES, Liew GC. Traumatic bleb-associated Group-G beta-haemolytic Streptococcus endophthalmitis. Clin Exp Ophthalmol 2009; 36:580-1. [PMID: 18954323 DOI: 10.1111/j.1442-9071.2008.01834.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rantala S, Vuopio-Varkila J, Vuento R, Huhtala H, Syrjänen J. Clinical presentations and epidemiology of beta-haemolytic streptococcal bacteraemia: a population-based study. Clin Microbiol Infect 2009; 15:286-8. [PMID: 19175622 DOI: 10.1111/j.1469-0691.2008.02672.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
In this population-based study, all 314 episodes of beta-haemolytic streptococcal bacteraemia in adult patients in the Pirkanmaa area, Finland, during the 10-year period 1995-2004 were retrospectively reviewed. Altogether, 92 cases of bacteraemia caused by Lancefield group A beta-haemolytic streptococci (GAS), 76 caused by group B beta-haemolytic streptococci (GBS), 18 caused by group C beta-haemolytic streptococci (GCS) and 128 caused by group G beta-haemolytic streptococci (GGS) were identified. The most important finding was that the incidence of GGS increased during the study period. Disruption of the cutaneous barrier was a very common predisposing factor in GAS and GGS bacteraemias. Skin infections were the presenting clinical manifestations in two-thirds of GAS and GGS bacteraemias.
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Affiliation(s)
- S Rantala
- Department of Internal Medicine, Tampere University Hospital, Tampere, Finland.
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26
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Liao CH, Liu LC, Huang YT, Teng LJ, Hsueh PR. Bacteremia caused by group G Streptococci, taiwan. Emerg Infect Dis 2008; 14:837-40. [PMID: 18439377 PMCID: PMC2600252 DOI: 10.3201/eid1405.070130] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
A retrospective observational study in Taiwan, 1998–2004, identified 92 patients with group G streptococcal bacteremia; 86 had Streptococcus dysgalactiae subspecies equisimilis. The most common diagnosis was cellulitis (48 cases), followed by primary bacteremia (34 cases). Infection recurred in 9 patients. Mortality rate was low (3.3%); resistance to quinupristin-dalfopristin was high.
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27
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Ishioka H, Hayakawa K, Shinozaki S, Umezawa M, Hatakeyama S. Group G streptococcal bacteremia and vertebral osteomyelitis in a homosexual man with amebic colitis. Intern Med 2008; 47:317-20. [PMID: 18277038 DOI: 10.2169/internalmedicine.47.0516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We present a case of bacteremia caused by group G streptococci (GGS) and vertebral osteomyelitis in a homosexual man with amebic colitis. The organism likely entered the blood via the inflamed intestinal mucosa resulting from amebiasis. Arthritis of both hands, which probably represented poststreptococcal reactive arthritis, was also observed. We should be aware that diseases caused by GGS appear to be increasing in recent years, and a potential for serious infection exists with regard to GGS as well as group A streptococci.
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Affiliation(s)
- Haruhiko Ishioka
- Department of Internal Medicine, Tokyo Metropolitan Health and Medical Treatment Corporation Okubo Hospital, Tokyo, Japan
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28
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Linge HM, Sastalla I, Nitsche-Schmitz DP, Egesten A, Frick IM. Protein FOG is a moderate inducer of MIG/CXCL9, and group G streptococci are more tolerant than group A streptococci to this chemokine's antibacterial effect. Microbiology (Reading) 2007; 153:3800-3808. [DOI: 10.1099/mic.0.2007/009647-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Helena M. Linge
- Department of Clinical Sciences Lund, Division of Respiratory Medicine and Allergology, Lund University, BMC, B14, SE-221 84 Lund, Sweden
- Department of Clinical Sciences Lund, Division of Infection Medicine, Lund University, BMC, B14, SE-221 84 Lund, Sweden
| | - Inka Sastalla
- Helmholtz Zentrum für Infektionsforschung, Abteilung Mikrobielle Pathogenität, Inhoffenstrasse 7, D-381 24 Braunschweig, Germany
| | - D. Patric Nitsche-Schmitz
- Helmholtz Zentrum für Infektionsforschung, Abteilung Mikrobielle Pathogenität, Inhoffenstrasse 7, D-381 24 Braunschweig, Germany
| | - Arne Egesten
- Department of Clinical Sciences Lund, Division of Respiratory Medicine and Allergology, Lund University, BMC, B14, SE-221 84 Lund, Sweden
| | - Inga-Maria Frick
- Department of Clinical Sciences Lund, Division of Infection Medicine, Lund University, BMC, B14, SE-221 84 Lund, Sweden
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29
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Pati S, Al-Araji A, Orendi J. Atypical presentation of Streptococcus zooepidemicus bacteraemia and secondary meningitis. Clin Neurol Neurosurg 2007; 109:475-6. [PMID: 17336452 DOI: 10.1016/j.clineuro.2007.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2006] [Revised: 01/24/2007] [Accepted: 01/30/2007] [Indexed: 10/23/2022]
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Abstract
Necrotizing fasciitis is a devastating soft tissue infection affecting fascias and subcutaneous soft tissues. Literature reviews have identified several related risk factors, including malignancy, alcoholism, malnutrition, diabetes, male gender and old age. There are only scanty case reports in the literature describing its rare association with colorectal malignancy. All published cases are attributed to bowel perforation resulting in necrotizing fasciitis over the perineal region. Isolated upper or lower limb diseases are rarely identified. Simultaneous upper and lower limb infection in colorectal cancer patients has never been described in the literature. We report an unusual case of multi-limb necrotizing fasciitis in a patient with underlying non-perforated rectal carcinoma.
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Affiliation(s)
- Shirley Yuk Wah Liu
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, HKSAR, China
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31
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Laupland KB, Ross T, Church DL, Gregson DB. Population-based surveillance of invasive pyogenic streptococcal infection in a large Canadian region. Clin Microbiol Infect 2006; 12:224-30. [PMID: 16451408 DOI: 10.1111/j.1469-0691.2005.01345.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pyogenic streptococci are a major cause of invasive infection. This study presents the results of a population-based laboratory surveillance for invasive pyogenic streptococcal infections among residents of the Calgary Health Region (population 1 million) between 1 July 1999 and 30 June 2004. The overall annual incidence rate was 18.65/100,000 population, with isolates belonging to the Streptococcus milleri group forming the most important aetiology (incidence of 8.65/100,000 population). Invasive infection with groups A, B, G and C streptococci occurred at annual rates of 4.27, 3.13, 1.83 and 0.41/100,000 population, respectively. There was a close relationship between increasing age and development of an invasive pyogenic streptococcal infection, and the incidence of infection was higher among males than among females. Differences in the seasonal occurrence and focus of infection occurred between the different groups.
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Affiliation(s)
- K B Laupland
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
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32
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Nitsche DP, Johansson HM, Frick IM, Mörgelin M. Streptococcal protein FOG, a novel matrix adhesin interacting with collagen I in vivo. J Biol Chem 2005; 281:1670-9. [PMID: 16278217 DOI: 10.1074/jbc.m506776200] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Group G streptococcus (GGS) is a human pathogen of emerging clinical significance. It causes skin and soft tissue infections, occasionally resulting in life-threatening conditions such as sepsis and necrotizing fasciitis. We recently identified FOG, a novel surface protein of GGS with fibrinogen binding and immune evasion properties. Here we investigated the role of FOG in streptococcal primary adhesion to host tissue. A FOG-expressing clinical isolate adhered more efficiently to human skin biopsies ex vivo and to the murine dermis in vivo than a FOG-deficient strain. Scanning and transmission electron microscopy of skin specimens exhibited that this property was assigned to the ability of FOG to interact with collagen I, a major interstitial component of the dermis. Overlay experiments with human skin extracts and radiolabeled FOG followed by matrix-assisted laser desorption/ionization time of flight mass spectrometry analysis identified both the alpha1- and alpha2-chains of collagen I as targets for FOG. Transmission electron microscopy of the molecular complexes revealed thread-like FOG molecules binding via their NH2 termini to distinct sites on collagen I monomers and fibrils. The results demonstrate that FOG is important for GGS adhesion in vivo, implying a pathogenic role for this surface protein.
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Affiliation(s)
- D Patric Nitsche
- Department of Clinical Sciences, Section for Clinical and Experimental Infectious Medicine, Biomedical Center, Lund University, S-22184 Lund, Sweden
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33
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Bloom C, Thomson EC, Main J. An elderly lady with sudden blindness and a sore foot. J Infect 2005; 52:e53-4. [PMID: 16002147 DOI: 10.1016/j.jinf.2005.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2005] [Accepted: 05/03/2005] [Indexed: 10/25/2022]
Abstract
We report the case of an elderly woman presenting with group G streptococcal septicaemia associated with osteomyelitis and endophthalmitis.
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Affiliation(s)
- C Bloom
- Department of Infectious Diseases, St Mary's Hospital, London W2, UK
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34
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MacDonald J, Lennox PA. Unusual Etiology of Simultaneous Deep Space Hand Infection and Necrotizing Fasciitis of the Foot. Plast Reconstr Surg 2005; 116:10e-13e. [PMID: 15988240 DOI: 10.1097/01.prs.0000169939.08625.e8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Jeannie MacDonald
- Department of Plastic Surgery, University of British Columbia, Vancouver, Vancouver, British Columbia, Canada.
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35
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Cohen-Poradosu R, Jaffe J, Lavi D, Grisariu-Greenzaid S, Nir-Paz R, Valinsky L, Dan-Goor M, Block C, Beall B, Moses AE. Group G streptococcal bacteremia in Jerusalem. Emerg Infect Dis 2004; 10:1455-60. [PMID: 15496248 PMCID: PMC3320404 DOI: 10.3201/eid1008.030840] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Recurrent group G Steptococcus bacteremia, associated with lymphatic disorders and possibly emmstG840.0, is described. Group G Streptococcus (GGS) can cause severe infections, including bacteremia. These organisms often express a surface protein homologous to the Streptococcus pyogenes M protein. We retrospectively studied the characteristics of patients from the Hadassah Medical Center with GGS bacteremia from 1989 to 2000. Ninety-four cases of GGS bacteremia were identified in 84 patients. The median age was 62 years, 54% were males, and 92% had underlying diseases (35% had a malignancy, and 35% had diabetes mellitus). The most frequent source for bacteremia was cellulitis (61%). emm typing of 56 available isolates disclosed 13 different types, including 2 novel types. Six patients had recurrent bacteremia with two to four bacteremic episodes, five had chronic lymphatic disorders, and two had emm type stG840.0 in every episode. Recurrent bacteremia has not been described for invasive group A Streptococcus. We describe an entity of recurrent GGS bacteremia, which is associated with lymphatic disorders and possibly with emm stG840.0.
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Affiliation(s)
| | - Joseph Jaffe
- Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - David Lavi
- Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Ran Nir-Paz
- Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Lea Valinsky
- Ministry of Health Central Laboratory, Jerusalem, Israel
| | - Mary Dan-Goor
- Hebrew University-Hadassah Medical School, Jerusalem, Israel
| | - Colin Block
- Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Bernard Beall
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Allon E. Moses
- Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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36
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Tong SHY, Tang WM, Wong JWK. Group G streptococcus--a rare cause of osteomyelitis simulating bone tumour: a case report. J Orthop Surg (Hong Kong) 2003; 11:221-3. [PMID: 14676352 DOI: 10.1177/230949900301100221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We report a case of osteomyelitis of the proximal femur caused by Lancefield group G streptococcus in a 71-year-old otherwise healthy man. The organism has rarely been identified as the cause of osteomyelitis. The subacute nature of the symptoms and the radiological appearance of the femur in this patient mimic bone tumour. The patient was successfully treated with conservative methods, including a prolonged period of oral antibiotics. We stress the importance of histological and bacteriological evidence in avoiding misdiagnosing patients with equivocal clinical and radiological presentation.
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Affiliation(s)
- S H Y Tong
- Department of Orthopaedic Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
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37
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Hallevy C, Sperber AD, Almog Y. Group G streptococcal empyema complicating primary intestinal lymphangiectasia. J Clin Gastroenterol 2003; 37:270. [PMID: 12960729 DOI: 10.1097/00004836-200309000-00015] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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38
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Hassan AA, Khan IU, Lammler C. Identification of Streptococcus dysgalactiae strains of Lancefield's group C, G and L by polymerase chain reaction. JOURNAL OF VETERINARY MEDICINE. B, INFECTIOUS DISEASES AND VETERINARY PUBLIC HEALTH 2003; 50:161-5. [PMID: 12916688 DOI: 10.1046/j.1439-0450.2003.00650.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Streptococcus dysgalactiae serogroup C, G and L strains were investigated by polymerase chain reaction (PCR) using oligonucleotide primers designed according to species-specific parts of the 16S-23S rDNA intergenic spacer region. The oligonucleotide primers with specificity for the 16S-23S rDNA intergenic spacer region allowed a correct identification of all S. dysgalactiae serogroups C, G and L strains investigated. No cross-reactivities could be observed with any of the control strains indicating the usefulness of PCR-technology to identify the serologically heterogeneous species S. dysgalactiae.
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Affiliation(s)
- A A Hassan
- Institut für Pharmakologie und Toxikologie, Justus-Liebig-Universität Giessen, Giessen, Germany
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39
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Hindsholm M, Schønheyder HC. Clinical presentation and outcome of bacteraemia caused by beta-haemolytic streptococci serogroup G. APMIS 2002; 110:554-8. [PMID: 12390413 DOI: 10.1034/j.1600-0463.2002.11007806.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
There has been a considerable increase in annual cases of bacteraemia caused by beta-haemolytic streptococci serogroup G (GGS) and we therefore undertook a retrospective case review in the Danish County of Northern Jutland. During a 19-year period (1981-1999) 94 cases were identified in a regional bacteraemia register, and the annual incidence rose from 3.0 per 106 inhabitants in 1981-1987 to 7.4 in 1988-1993 and 17.2 in 1994-1999. Clinical charts were available for 92 cases. The male/female ratio was 52/40 and the median age 71 years, range 15-97 years. Twenty-seven patients had reduced functional capacity. Fifty-two cases were community-acquired. The most common site of infection was the skin followed by the lungs and the urogenital tract. Eleven patients had no apparent site of infection. Underlying disease was present in 81 patients, who shared 149 co-morbid conditions, and the overall one-month case fatality rate was 23% (95% confidence limits 15-33%). We conclude that GGS are of increasing importance as a cause of bacteraemic infections and first and foremost affect patients who are aged, debilitated, or suffer from severe or multiple underlying diseases.
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40
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Sylvetsky N, Raveh D, Schlesinger Y, Rudensky B, Yinnon AM. Bacteremia due to beta-hemolytic Streptococcus group G: increasing incidence and clinical characteristics of patients. Am J Med 2002; 112:622-6. [PMID: 12034411 DOI: 10.1016/s0002-9343(02)01117-8] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE To describe the epidemiology and clinical characteristics of patients diagnosed with Streptococcus group G bacteremia from 1990 to 1999 at a community teaching hospital in Israel. SUBJECTS AND METHODS We calculated the annual rate of bacteremia with Streptococcus group G, expressed as a percentage of positive blood cultures (after excluding contaminants) and per 1000 admissions. Medical records of patients with Streptococcus group G were reviewed. RESULTS During the 10-year study period, there was a total of 7415 positive blood cultures, 327 (4.4%) of which were beta-hemolytic Streptococcus species, of which 49 (15%) were group G. The rate of Streptococcus group G bacteremia per 1000 admissions increased from zero (0/18,783) in 1990 to 0.41 (13/31,440) in 1999 (P = 0.001), surpassing Streptococcus group A in frequency. Of the 47 patients with Streptococcus group G, 40 medical records were available for review: 25 patients (63%) were older than 75 years and 32 (80%) were men. The probable source of Streptococcus group G bacteremia was a skin or soft tissue infection in 37 patients (93%). Six of the 40 patients died. CONCLUSION Community-acquired group G streptococcal bacteremia occurred with increasing frequency from 1990 to 1999 at our hospital. Most patients were elderly men, and the portal of entry was usually the skin or soft tissue. Our findings suggest a change in the epidemiology of bacteremia due to beta-hemolytic streptococci.
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Affiliation(s)
- Noa Sylvetsky
- Infectious Diseases Unit, Department of Internal Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
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41
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Humar D, Datta V, Bast DJ, Beall B, De Azavedo JCS, Nizet V. Streptolysin S and necrotising infections produced by group G streptococcus. Lancet 2002; 359:124-9. [PMID: 11809255 DOI: 10.1016/s0140-6736(02)07371-3] [Citation(s) in RCA: 111] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND We encountered three patients with severe necrotising soft tissue infections due to beta-haemolytic group G streptococcus. Due to strong clinical similarities with invasive infections produced by group A streptococcus, we investigated a potential link of shared beta-haemolytic phenotype to disease pathogenesis. METHODS Hybridisation, DNA sequencing, targeted mutagenesis, and complementation studies were used to establish the genetic basis for group G streptococcus beta-haemolytic activity. The requirement of group G streptococcus beta-haemolysin in producing necrotising infection was examined in mice. FINDINGS Each patient had an underlying medical condition. beta-haemolytic group G streptococcus was the sole microbial isolate from debrided necrotic tissue. The group G streptococcus chromosome contained a homologue of the nine-gene group A streptococcus sag operon encoding the beta-haemolysin streptolysin S (SLS). Targeted mutagenesis of the putative SLS structural gene sagA in group G streptococcus eliminated beta-haemolytic activity. Mice injected subcutaneously with wild-type group A streptococcus or group G streptococcus developed an inflammatory lesion with high bacterial counts, marked neutrophil infiltration, and histopathological evidence of diffuse tissue necrosis. These changes were not found in mice injected with the isogenic group A streptococcus or group G streptococcus SLS-negative mutants. INTERPRETATION In patients with underlying medical conditions, beta-haemolytic group G streptococcus can produce necrotising soft tissue infections resembling those produced by group A streptococcus. The beta-haemolytic phenotype of group G streptococcus is produced by the exotoxin SLS, encoded by a functional homologue of the nine-gene group A streptococcus sag operon. SLS expression contributes to the pathogenesis of streptococcal necrotising soft tissue infection.
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Affiliation(s)
- Deepali Humar
- Department of Medicine, Division of Infectious Diseases, University of California, San Diego 92093, USA.
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42
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Luyx C, Vanpee D, Glupczynski Y, Swine C, Gillet JB. Delayed diagnosis of meningitis caused by beta-haemolytic group G. Streptococcus in an older woman. J Emerg Med 2001; 21:393-6. [PMID: 11728766 DOI: 10.1016/s0736-4679(01)00406-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A case of meningitis caused by group G beta-hemolytic Streptococcus (dysgalactiae, subspecies equisimilis) is reported in an 83-year-old woman. Streptococci species other than Streptococcus pneumoniae are seldom found in patients with acute bacterial meningitis, therefore, our discussion is focused on this rare organism. The question of the diagnosis of meningitis in the elderly is also addressed.
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Affiliation(s)
- C Luyx
- Department of Emergency Medicine, Université Catholique de Louvain, Mont-Godinne Hospital, 5530, Yvoir, Belgium
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43
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Streptococcal Screening in Obstetrics. Obstet Gynecol 2001. [DOI: 10.1097/00006250-200111000-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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44
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Woo PC, Fung AM, Lau SK, Wong SS, Yuen KY. Group G beta-hemolytic streptococcal bacteremia characterized by 16S ribosomal RNA gene sequencing. J Clin Microbiol 2001; 39:3147-55. [PMID: 11526143 PMCID: PMC88311 DOI: 10.1128/jcm.39.9.3147-3155.2001] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Little is known about the relative importance of the four species of Lancefield group G beta-hemolytic streptococci in causing bacteremia and the factors that determine the outcome for patients with group G beta-hemolytic streptococcal bacteremia. From 1997 to 2000, 75 group G beta-hemolytic streptococcal strains were isolated from the blood cultures of 66 patients. Sequencing of the 16S rRNA genes of the group G beta-hemolytic streptococci showed that all 75 isolates were Streptococcus dysgalactiae subspecies equisimilis. The API system (20 STREP) and Vitek system (GPI) successfully identified 65 (98.5%) and 62 (93.9%) isolates, respectively, as S. dysgalactiae subspecies equisimilis with >95% confidence, whereas the ATB Expression system (ID32 STREP) only successfully identified 49 isolates (74.2%) as S. dysgalactiae subspecies equisimilis with >95% confidence. The median age of the patients was 76 years (range, 33 to 99 years). Fifty-six patients (85%) were over 60 years old. All patients had underlying diseases. No source of the bacteremia was identified (primary bacteremia) in 34 patients (52%), whereas 17 (26%) had cellulitis and 8 (12%) had bed sore or wound infections. Fifty-eight patients (88%) had community-acquired group G streptococcal bacteremia. Sixty-two patients (94%) had group G Streptococcus recovered in one blood culture, whereas 4 patients (6%) had it recovered in multiple blood cultures. Fifty-nine patients (89%) had group G Streptococcus as the only bacterium recovered in their blood cultures, whereas in 7 patients other bacteria were recovered concomitantly with the group G Streptococcus in the blood cultures (Staphylococcus aureus in 3, Clostridium perfringens in 2, Citrobacter freundii in 1, and Bacteroides fragilis in 1). Overall, 10 patients (15%) died. Male sex, diagnosis other than cellulitis, hospital-acquired bacteremia, and multiple positive blood cultures were associated with mortality [P < 0.005 (relative risk [RR] = 7.6), P < 0.05 (RR = 3.7), P < 0.005 (RR = 5.6), and P < 0.05 (RR = 5.6), respectively]. Unlike group C beta-hemolytic streptococcal bacteremia, group G beta-hemolytic streptococcal bacteremia is not a zoonotic infection in Hong Kong.
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Affiliation(s)
- P C Woo
- Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
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45
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Zaoutis T, Moore LS, Furness K, Klein JD. In vitro activities of linezolid, meropenem, and quinupristin-dalfopristin against group C and G streptococci, including vancomycin-tolerant isolates. Antimicrob Agents Chemother 2001; 45:1952-4. [PMID: 11408207 PMCID: PMC90584 DOI: 10.1128/aac.45.7.1952-1954.2001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The in vitro activities of meropenem, linezolid, quinupristin-dalfopristin, vancomycin, and penicillin against 130 clinical isolates of group C and G streptococci, including vancomycin-tolerant isolates, were evaluated. Meropenem, linezolid, quinupristin-dalfopristin, vancomycin, and penicillin MICs at which 90% of the isolates were inhibited were 0.06, 2.0, 0.25, 0.5, and < or = 0.016 microg/ml, respectively. Meropenem, linezolid, quinupristin-dalfopristin, and penicillin were active against group C and G streptococci, including vancomycin-resistant strains.
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Affiliation(s)
- T Zaoutis
- Division of Pediatric Infectious Diseases, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
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46
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Hansmann Y. De quelles données a-t-on besoin aujourd’hui pour prendre en charge un érysipèle? Med Mal Infect 2000. [DOI: 10.1016/s0399-077x(01)80015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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47
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Perl B, Gottehrer NP, Raveh D, Schlesinger Y, Rudensky B, Yinnon AM. Cost-effectiveness of blood cultures for adult patients with cellulitis. Clin Infect Dis 1999; 29:1483-8. [PMID: 10585800 DOI: 10.1086/313525] [Citation(s) in RCA: 122] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
To assess the cost-effectiveness of blood cultures for patients with cellulitis, a retrospective review was conducted of clinical and microbiological data for all 757 patients admitted to a medical center because of community-acquired cellulitis during a 41-month period. Blood cultures were performed for 553 patients (73%); there were a total of 710 blood samples (i.e., a mean of 1.3 cultures were performed per patient). In only 11 cases (2.0%) was a significant patient-specific microbial strain isolated, mainly beta-hemolytic streptococci (8 patients [73%]). An organism that was considered a contaminant was isolated from an additional 20 culture bottles (3. 6%). The cost of laboratory workup of the 710 culture sets was $36, 050. Isolation of streptococci led to a change from empirical treatment with cefazolin to penicillin therapy for 8 patients. All patients recovered. In conclusion, the yield of blood cultures is very low, has a marginal impact on clinical management, and does not appear to be cost-effective for most patients with cellulitis.
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Affiliation(s)
- B Perl
- Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem 91031, Israel
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48
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Zaoutis T, Schneider B, Steele Moore L, Klein JD. Antibiotic susceptibilities of group C and group G streptococci isolated from patients with invasive infections: evidence of vancomycin tolerance among group G serotypes. J Clin Microbiol 1999; 37:3380-3. [PMID: 10488212 PMCID: PMC85574 DOI: 10.1128/jcm.37.10.3380-3383.1999] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A retrospective review of medical records for 32 patients with invasive group C streptococcus (GCS) or group G streptococcus (GGS) infections was performed. MICs and minimum bactericidal concentrations (MBCs) of penicillin, erythromycin, and vancomycin for all isolates were obtained. Tolerance of vancomycin, defined as an MBC 32 or more times higher than the MIC, was exhibited by 18 GGS isolates (54%). The identification of tolerance in clinical isolates of GGS and GCS may have clinical implications in treating these seriously ill patients.
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Affiliation(s)
- T Zaoutis
- Division of Pediatric Infectious Diseases, Alfred I. duPont Hospital for Children, Wilmington, Delaware 19899, USA
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49
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Schattner A, Vosti KL. Bacterial arthritis due to beta-hemolytic streptococci of serogroups A, B, C, F, and G. Analysis of 23 cases and a review of the literature. Medicine (Baltimore) 1998; 77:122-39. [PMID: 9556703 DOI: 10.1097/00005792-199803000-00004] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
The clinical features, essential laboratory findings, management, and outcome of all 23 cases of septic arthritis caused by different serogroups of beta-hemolytic streptococcus (BHS) seen at the Stanford Medical Center, Stanford, CA, from July 1, 1985, through October 31, 1996, were reviewed and compared to those found in the literature. Group A streptococci (GAS) accounted for 9 (40%) of our cases; group B (GBS), for 7 (30%); and Group G (GGS), for 7 (30%). No cases were caused by Group C (GCS) or F (GFS) during this period. During the same period, GAS accounted for 66 (33%) of 200 cases of bacteremia due to BHS, GBS, for 98 (49%); GCS, for 12 (6%); GFS, for 4 (2%); and GGS, for 20 (10%). A review of potential risk factors revealed that, with the exception of GGS, male and female patients were almost equally distributed among each of the serogroups. Patients aged 50 years and older comprised 56%-77% of each group. Associated conditions and risk factors were present among most patients (19/23, 83%); autoimmune diseases and a chronic skin wound or trauma were notably present among patients with GAS, while diabetes mellitus and malignancy were more common among patients with GBS. Infected prosthetic implants were present in 7 patients, including 4/7 patients with GGS. All patients had positive cultures of synovial fluid, and 11/23 (49%) had positive blood cultures (GAS, 5/9; GBS, 6/7; and GGS, 0/7). The clinical presentation and hospital course of patients infected with the different serogroups varied. Patients infected with GAS had the most severe disease and those with GGS the least severe. Necrotizing fascitis, shock, DIC, and admission to the intensive care unit were found only among patients infected with GAS. Despite aggressive management with antimicrobial therapy and surgery, 4/23 patients died (3 patients with GAS; 1 with GBS). The isolates from our patients were not available for study; investigations by others of the biology of BHS suggest that the production of 1 or more of the streptococcal pyrogenic exotoxins by isolates of GAS may account for the differences in the severity of disease among our patients with septic arthritis caused by different serogroups of BHS. Although septic arthritis due to BHS is uncommon, such patients provide a valuable model to study features of the host-parasite interaction that may contribute to the observed differences in severity of disease.
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Affiliation(s)
- A Schattner
- Hebrew University Hadassah Medical School, Jerusalem, Israel
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50
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Tsambiras PE, Montero JA, Greene JN, Sandin R. Recurrent Cellulitis With Group G Streptococcus Bacteremia in a Cancer Patient: A Case Report. Cancer Control 1998; 5:184-186. [PMID: 10761030 DOI: 10.1177/107327489800500212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- PE Tsambiras
- Department of Internal Medicine, University of South Florida College of Medicine, Tampa, Florida 33612, USA
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