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Group A streptococcal (Streptococcus pyogenes) bacteremia in adults

INTRODUCTION

Group A streptococcus (GAS, eg, Streptococcus pyogenes) is an aerobic gram-positive coccus that causes pharyngitis and a variety of cutaneous infections (eg, pyoderma, erysipelas, cellulitis), invasive infections, and other complications such as acute rheumatic fever, acute glomerulonephritis, and toxic shock syndrome (TSS). Invasive GAS infections are defined as bacteremia, pneumonia, or any other infection associated with the isolation of GAS from a normally sterile body site [1]. Invasive infections also include necrotizing fasciitis and spontaneous gangrenous myositis.

The epidemiology, clinical manifestations, treatment, and prognosis of GAS bacteremia in adults will be reviewed here. Issues related to GAS bacteremia in children and to other GAS infections (TSS and invasive disease) are discussed separately. (See "Group A streptococcal (Streptococcus pyogenes) bacteremia in children" and "Epidemiology, clinical manifestations, and diagnosis of streptococcal toxic shock syndrome" and "Treatment of streptococcal toxic shock syndrome" and "Necrotizing infections of the skin and fascia" and "Spontaneous gangrenous myositis caused by Streptococcus pyogenes".)

EPIDEMIOLOGY

GAS bacteremia is usually secondary to a primary site of infection, which most commonly occurs in the skin and soft tissues [2,3]. The frequency with which it occurs was evaluated in a review of blood cultures from a single institution in Israel over a 10-year period (1993-2002) [4]. GAS accounted for 0.6 percent of cases of bacteremia in adults and GAS bacteremia was diagnosed in 1 in 500 hospitalizations.

An increasing prevalence of severe GAS infections occurred between 1985 and 1994, predominantly from North America and Europe [5-8]. A study in Norway, for example, found a threefold increase in the occurrence of GAS bacteremia in 1987 to 1988 compared to previous years [6]. The greatest increase (six- to eightfold) was in adolescents and in adults between the ages of 30 and 50.

Since that time attack rates have been stable. In the United States in 2003, approximately 1190 invasive GAS infections were reported [9]. The incidence is probably much higher since passive reporting underestimates the disease. The Centers for Disease Control and Prevention (CDC) estimates that approximately 11,000 cases of invasive GAS disease and 1700 deaths occurred nationally during 2003 [9].
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References Top
  1. Stevens, DL. Invasive group A streptococcus infections. Clin Infect Dis 1992; 14:2.
  2. Kiska, DL, Thiede, B, Caracciolo, J, et al. Invasive group A streptococcal infections in North Carolina: epidemiology, clinical features, and genetic and serotype analysis of causative organisms. J Infect Dis 1997; 176:992.
  3. Demers, B, Simor, AE, Velland, H, et al. Severe Invasive group A streptococcal infections in Ontario, Canada: 1987-1991. Clin Infect Dis 1993; 16:792.
  4. Megged, O, Yinnon, AM, Raveh, D, et al. Group A streptococcus bacteraemia: comparison of adults and children in a single medical centre. Clin Microbiol Infect 2006; 12:156.
  5. Gaworzewska, E, Colman, G. Changes in the patterns of infection caused by Streptococcus pyogenes. Epidemiol Infect 1988; 100:257.
  6. Martin, PR, Hoiby, EA. Streptococcal serogroup A epidemic in Norway 1987-1988. Scand J Infect Dis 1990; 22:421.
  7. Schwartz, B, Facklam, RR, Brieman, RF. Changing epidemiology of Group A streptococcal infection in the USA. Lancet 1990; 336:1167.
  8. Holm, SE, Norrby, A, Bergholm, AM, Norgren, M. Aspects of pathogenesis of serious group A streptococcal infections in Sweden, 1988-1989. J Infect Dis 1992; 166:31.
  9. Hopkins, RS, Jajosky, RA, Hall, PA, et al. Summary of notifiable diseases--United States, 2003. MMWR Morb Mortal Wkly Rep 2005; 52:1.
  10. Stevens, DL, Tanner, MH, Winship, J, et al. Reappearance of scarlet fever toxin A among streptococci in the Rocky Mountain West: Severe group A streptococcal infections associated with a toxic shock-like syndrome. N Engl J Med 1989; 321:1.
  11. Stevens, DL, Salmi, D, McIndoo, E, et al. Molecular epidemiology of nga and NAD glycohydrolase/ADP-ribosyltransferase activity among Streptococcus pyogenes causing streptococcal toxic shock syndrome. J Infect Dis 2000; 182:1117.
  12. Keefer, CS, Ingelfinger, FJ, Spink, WW. Significance of hemolytic streptococcic bacteremia; A study of two hundred and forty-six patients. Arch Intern Med 1937; 60:1084.
  13. Ispahani, P, Donald, FE, Aveline, AJ. Streptococcus pyogenes bacteremia: An old enemy subdued, but not defeated. J Infect 1988; 16:37.
  14. Henkel, JS, Armstrong, D, Blevins, A, Moody, MD. Group A beta-hemolytic streptococcus bacteremia in a cancer hospital. JAMA 1970; 211:983.
  15. Hable, KA, Horstmeier, C, Wold, AD, Washington, JA. Group A beta-hemolytic streptococcemia. Bacteriological and clinical study of 44 cases. Mayo Clin Proc 1973; 48:336.
  16. Trence, DL, Khan, MY, Gerding, DN. Beta-hemolytic streptococcal bacteremia in adults: association with cold weather in Minnesota. Minn Med 1981; 64:675.
  17. Barg, NL, Kish, MA, Kauffman, CA, Supena, RB. Group A streptococcal bacteremia in intravenous drug abusers. Am J Med 1985; 78:569.
  18. Francis, J, Warren, RE. Streptococcus pyogenes bacteraemia in Cambridge - A review of 67 episodes. Q J Med 1988; 256:603.
  19. Barnham, M. Invasive streptococcal infections in the era before the acquired immune deficiency syndrome: A 10 years' compilation of patients with streptococcal bacteraemia in North Yorkshire. J Infect 1989; 18:231.
  20. Braunstein, H. Characteristics of group A streptococcal bacteremia in patients at the San Bernardino County Medical Center. Rev Infect Dis 1991; 13:8.
  21. Tyrrell, GJ, Lovgren, M, Kress, B, Grimsrud, K. Invasive group A streptococcal disease in Alberta, Canada (2000 to 2002). J Clin Microbiol 2005; 43:1678.
  22. Muller, MP, Low, DE, Green, KA, et al. Clinical and epidemiologic features of group a streptococcal pneumonia in Ontario, Canada. Arch Intern Med 2003; 163:467.
  23. Kaul, R, McGeer, A, Low, DE, et al. Population-based surveillance for group A streptococcal necrotizing fasciitis: Clinical features, prognostic indicators, and microbiologic analysis of seventy-seven cases. Ontario Group A Streptococcal Study. Am J Med 1997; 103:18.
  24. Bernaldo de Quiros, JC, Moreno, S, Cercenado, E, et al. Group A streptococcal bacteremia. A 10-year prospective study. Medicine 1997; 76:238.
  25. Davies, HD, McGeer, A, Schwartz, B, et al. Invasive group A streptococcal infections in Ontario, Canada. N Engl J Med 1996; 335:547.
  26. Ejlertsen, T, Prag, J, Pettersson, E, Holmskov, A. A 7-month outbreak of relapsing postpartum group A streptococcal infections linked to a nurse with atopic dermatitis. Scand J Infect Dis 2001; 33:734.
  27. Factor, SH. Invasive group A streptococcal disease: risk factors for adults. Emerg Infect Dis 2003; 9:970.
  28. Nielsen, HU, Kolmos, HJ, Frimodt-Moller, N. Beta-hemolytic streptococcal bacteremia: a review of 241 cases. Scand J Infect Dis 2002; 34:483.
  29. Daneman, N, Green, KA, Low, DE, et al. Surveillance for hospital outbreaks of invasive group a streptococcal infections in Ontario, Canada, 1992 to 2000. Ann Intern Med 2007; 147:234.
  30. Ben-Abraham, R, Keller, N, Vered, R, et al. Invasive group A streptococcal infections in a large tertiary center: epidemiology, characteristics and outcome. Infection 2002; 30:81.
  31. Hollm-Delgado, MG, Allard, R, Pilon, PA. Invasive group A streptococcal infections, clinical manifestations and their predictors, Montreal, 1995-2001. Emerg Infect Dis 2005; 11:77.
  32. Bullowa, JGM, Wishik, SM. Complications of varicella I. Their occurrence among 2,534 patients. Am J Dis Child 1935; 49:923.
  33. Kaplan, EL, Johnson, DR, Kuritsky, JN. Rectal colonization by group B beta-hemolytic streptococci in a geriatric population. J Infect Dis 1983; 148:1120.
  34. Sierra, JM, Sanchez, F, Castro, P, et al. Group a streptococcal infections in injection drug users in barcelona, Spain: epidemiologic, clinical, and microbiologic analysis of 3 clusters of cases from 2000 to 2003. Medicine (Baltimore) 2006; 85:139.
  35. Doctor, A, Harper, MB, Fleisher, GR. Group A beta-hemolytic streptococcal bacteremia: historical overview, changing incidence, and recent association with varicella. Pediatrics 1995; 96:428.
  36. Gastanaduy, AS, Kaplan, EL, Huwe, BB, et al. Failure of penicillin to eradicate group A streptococci during an outbreak of pharyngitis. Lancet 1980; 2:498.
  37. Stevens, DL, Gibbons, AE, Bergstrom, R, Winn, V. The Eagle effect revisited: Efficacy of clindamycin, erythromycin, and penicillin in the treatment of streptococcal myositis. J Infect Dis 1988; 158:23.
  38. Stevens, DL, Bryant, AE, Yan, S. Invasive group A streptococcal infection: New concepts in antibiotic treatment. Int J Antimicrobial Agents 1994; 4:297.
  39. Zimbelman, J, Palmer, A, Todd, J. Improved outcome of clindamycin compared with beta-lactam antibiotic treatment for invasive Streptococcus pyogenes infection. Pediatr Infect Dis J 1999; 18:1096.
  40. Richter, SS, Heilmann, KP, Beekmann, SE, et al. Macrolide-resistant Streptococcus pyogenes in the United States, 2002-2003. Clin Infect Dis 2005; 41:599.
  41. Gooskens, J, Neeling, AJ, Willems, RJ, et al. Streptococcal toxic shock syndrome by an iMLS resistant M type 77 Streptococcus pyogenes in the Netherlands. Scand J Infect Dis 2005; 37:85.
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