Group A streptococcal (Streptococcus pyogenes) bacteremia in adults
- Dennis L Stevens, MD, PhD
Dennis L Stevens, MD, PhD
- Professor of Medicine
- University of Washington School of Medicine
Group A Streptococcus (GAS; Streptococcus pyogenes) is an aerobic gram-positive coccus that causes an array of infections, including:
●A variety of cutaneous infections (eg, cellulitis, erysipelas, pyoderma)
●Myositis or myonecrosis
●PharyngitisTo continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- Stevens DL. Invasive group A streptococcus infections. Clin Infect Dis 1992; 14:2.
- 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.
- Demers B, Simor AE, Vellend H, et al. Severe invasive group A streptococcal infections in Ontario, Canada: 1987-1991. Clin Infect Dis 1993; 16:792.
- 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.
- Gaworzewska E, Colman G. Changes in the pattern of infection caused by Streptococcus pyogenes. Epidemiol Infect 1988; 100:257.
- Martin PR, Høiby EA. Streptococcal serogroup A epidemic in Norway 1987-1988. Scand J Infect Dis 1990; 22:421.
- Schwartz B, Facklam RR, Breiman RF. Changing epidemiology of group A streptococcal infection in the USA. Lancet 1990; 336:1167.
- 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.
- Oppegaard O, Mylvaganam H, Kittang BR. Beta-haemolytic group A, C and G streptococcal infections in Western Norway: a 15-year retrospective survey. Clin Microbiol Infect 2015; 21:171.
- Smit PW, Lindholm L, Lyytikäinen O, et al. Epidemiology and emm types of invasive group A streptococcal infections in Finland, 2008-2013. Eur J Clin Microbiol Infect Dis 2015; 34:2131.
- Ikebe T, Tominaga K, Shima T, et al. Increased prevalence of group A streptococcus isolates in streptococcal toxic shock syndrome cases in Japan from 2010 to 2012. Epidemiol Infect 2015; 143:864.
- Plainvert C, Loubinoux J, Bidet P, et al. [Epidemiology of Streptococcus pyogenes invasive diseases in France (2007-2011)]. Arch Pediatr 2014; 21 Suppl 2:S62.
- Stevens DL, Tanner MH, Winship J, et al. Severe group A streptococcal infections associated with a toxic shock-like syndrome and scarlet fever toxin A. N Engl J Med 1989; 321:1.
- Stevens DL, Salmi DB, McIndoo ER, Bryant AE. Molecular epidemiology of nga and NAD glycohydrolase/ADP-ribosyltransferase activity among Streptococcus pyogenes causing streptococcal toxic shock syndrome. J Infect Dis 2000; 182:1117.
- Meehan M, Murchan S, Bergin S, et al. Increased incidence of invasive group A streptococcal disease in Ireland, 2012 to 2013. Euro Surveill 2013; 18:20556.
- Centers for Disease Control and Prevention. Active Bacterial Core Surveillance (ABCs). ABCs Report: group A Streptococcus, 2005. www.cdc.gov/abcs/reports-findings/survreports/gas05.html (Accessed on July 14, 2011).
- Centers for Disease Control and Prevention. Active Bacterial Core Surveillance (ABCs). ABCs Report: group A Streptococcus, 2006. www.cdc.gov/abcs/reports-findings/survreports/gas06.html (Accessed on July 14, 2011).
- Centers for Disease Control and Prevention. Active Bacterial Core Surveillance (ABCs). ABCs Report: group A Streptococcus, 2007. www.cdc.gov/abcs/reports-findings/survreports/gas07.html (Accessed on July 14, 2011).
- Centers for Disease Control and Prevention. Active Bacterial Core Surveillance (ABCs). ABCs Report: group A Streptococcus, 2008. www.cdc.gov/abcs/reports-findings/survreports/gas08.html (Accessed on July 14, 2011).
- Centers for Disease Control and Prevention. Active Bacterial Core Surveillance (ABCs). ABCs Report: group A Streptococcus, 2009. www.cdc.gov/abcs/reports-findings/survreports/gas09.html (Accessed on July 14, 2011).
- Centers for Disease Control and prevention. Active Bacterial Core Surveillance (ABCs). ABCs Report: group A Streptococcus, 2010 www.cdc.gov/abcs/reports-findings/survreports/gas10.html (Accessed on May 15, 2012).
- Lepoutre A, Doloy A, Bidet P, et al. Epidemiology of invasive Streptococcus pyogenes infections in France in 2007. J Clin Microbiol 2011; 49:4094.
- Deutscher M, Schillie S, Gould C, et al. Investigation of a group A streptococcal outbreak among residents of a long-term acute care hospital. Clin Infect Dis 2011; 52:988.
- Centers for Disease Control and Prevention (CDC). Invasive group A streptococcus in a skilled nursing facility--Pennsylvania, 2009-2010. MMWR Morb Mortal Wkly Rep 2011; 60:1445.
- 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.
- Ispahani P, Donald FE, Aveline AJ. Streptococcus pyogenes bacteraemia: an old enemy subdued, but not defeated. J Infect 1988; 16:37.
- Henkel JS, Armstrong D, Blevins A, Moody MD. Group A beta-hemolytic Streptococcus bacteremia in a cancer hospital. JAMA 1970; 211:983.
- Hable KA, Horstmeier C, Wold AD, Washington JA 2nd. Group A -hemolytic streptococcemia. Bacteriologic and clinical study of 44 cases. Mayo Clin Proc 1973; 48:336.
- Trence DL, Khan MY, Gerding DN. Beta-hemolytic streptococcal bacteremia in adults: association with cold weather in Minnesota. Minn Med 1981; 64:675.
- Barg NL, Kish MA, Kauffman CA, Supena RB. Group A streptococcal bacteremia in intravenous drug abusers. Am J Med 1985; 78:569.
- Francis J, Warren RE. Streptococcus pyogenes bacteraemia in Cambridge--a review of 67 episodes. Q J Med 1988; 68:603.
- 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.
- Braunstein H. Characteristics of group A streptococcal bacteremia in patients at the San Bernardino County Medical Center. Rev Infect Dis 1991; 13:8.
- 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.
- 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.
- 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.
- Bernaldo de Quirós JC, Moreno S, Cercenado E, et al. Group A streptococcal bacteremia. A 10-year prospective study. Medicine (Baltimore) 1997; 76:238.
- Davies HD, McGeer A, Schwartz B, et al. Invasive group A streptococcal infections in Ontario, Canada. Ontario Group A Streptococcal Study Group. N Engl J Med 1996; 335:547.
- 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.
- Factor SH, Levine OS, Schwartz B, et al. Invasive group A streptococcal disease: risk factors for adults. Emerg Infect Dis 2003; 9:970.
- Tyrrell GJ, Lovgren M, St Jean T, et al. Epidemic of group A Streptococcus M/emm59 causing invasive disease in Canada. Clin Infect Dis 2010; 51:1290.
- Nielsen HU, Kolmos HJ, Frimodt-Møller N. Beta-hemolytic streptococcal bacteremia: a review of 241 cases. Scand J Infect Dis 2002; 34:483.
- 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.
- 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.
- 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.
- Langley G, Hao Y, Pondo T, et al. The Impact of Obesity and Diabetes on the Risk of Disease and Death due to Invasive Group A Streptococcus Infections in Adults. Clin Infect Dis 2016; 62:845.
- Kaplan EL, Johnson DR, Kuritsky JN. Rectal colonization by group B beta-hemolytic streptococci in a geriatric population. J Infect Dis 1983; 148:1120.
- Beaudoin AL, Torso L, Richards K, et al. Invasive group A Streptococcus infections associated with liposuction surgery at outpatient facilities not subject to state or federal regulation. JAMA Intern Med 2014; 174:1136.
- Sierra JM, Sánchez 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.
- Hamilton SM, Bayer CR, Stevens DL, Bryant AE. Effects of selective and nonselective nonsteroidal anti-inflammatory drugs on antibiotic efficacy of experimental group A streptococcal myonecrosis. J Infect Dis 2014; 209:1429.
- Hamilton SM, Bayer CR, Stevens DL, et al. Muscle injury, vimentin expression, and nonsteroidal anti-inflammatory drugs predispose to cryptic group A streptococcal necrotizing infection. J Infect Dis 2008; 198:1692.
- Bullowa JGM, Wishik SM. Complications of their occurrence among 2,534 patients. Am J Dis Child 1935; 49:923.
- Hamilton SM, Stevens DL, Bryant AE. Pregnancy-related group a streptococcal infections: temporal relationships between bacterial acquisition, infection onset, clinical findings, and outcome. Clin Infect Dis 2013; 57:870.
- Richter SS, Heilmann KP, Beekmann SE, et al. Macrolide-resistant Streptococcus pyogenes in the United States, 2002-2003. Clin Infect Dis 2005; 41:599.
- DeMuri GP, Sterkel AK, Kubica PA, et al. Macrolide and Clindamycin Resistance in Group a Streptococci Isolated From Children With Pharyngitis. Pediatr Infect Dis J 2017; 36:342.
- 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.
- Stevens DL, Bryant AE, Yan S. Invasive group A streptococcal infection: New concepts in antibiotic treatment. Int J Antimicrob Agents 1994; 4:297.
- 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.
- 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.
- 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.
- Chen I, Kaufisi P, Erdem G. Emergence of erythromycin- and clindamycin-resistant Streptococcus pyogenes emm 90 strains in Hawaii. J Clin Microbiol 2011; 49:439.
- Prevention of Invasive Group A Streptococcal Infections Workshop Participants. Prevention of invasive group A streptococcal disease among household contacts of case patients and among postpartum and postsurgical patients: recommendations from the Centers for Disease Control and Prevention. Clin Infect Dis 2002; 35:950.