Group C and group G streptococcal infection
- Michael R Wessels, MD
Michael R Wessels, MD
- John F Enders Professor of Pediatrics and Professor of Medicine (Microbiology and Immunobiology)
- Harvard Medical School
The designations "group C Streptococcus" (GCS) and "group G Streptococcus" (GGS) are used by clinical microbiology laboratories to denote clinical isolates of streptococci that react with Lancefield group C or G typing serum and, like Streptococcus pyogenes (group A Streptococcus), form large colonies on sheep blood agar, typically surrounded by a zone of beta-hemolysis.
GCS and GGS are normal commensal flora of the human upper airway and frequently are asymptomatic colonizers of the skin, gastrointestinal tract, and female genital tract. They are also implicated in mono- and polymicrobial infections of the skin and soft tissues, pharyngitis, bacteremia and endocarditis, septic arthritis and osteomyelitis, puerperal infections, and meningitis.
GCS and GGS of human origin are now considered to constitute a single subspecies, Streptococcus dysgalactiae subsp equisimilis. A comparison of the complete genome sequence of a clinical isolate of GGS S. dysgalactiae subsp equisimilis with that of other streptococcal species demonstrated it is most closely related to S. pyogenes, with 72 percent sequence similarity . S. dysgalactiae subsp equisimilis shares many virulence determinants with S. pyogenes, including the antiphagocytic M protein, streptolysin O, streptolysin S, streptokinase, and one or more pyrogenic exotoxins similar to those implicated in streptococcal toxic shock [1,2].
GCS and GGS of animal origin are occasionally associated with human infection; these bacteria belong to distinct species. (See 'Microbiology' below.)
Streptococci in the S. anginosus or S. milleri group may also react with C or G typing sera, but these organisms are distinguished by the fact that they form small (<0.5 mm) colonies on sheep blood agar. They are normally identified by diagnostic laboratories as belonging to the S. anginosus or S. milleri group, not as GCS or GGS. (See "Infections due to the Streptococcus anginosus (Streptococcus milleri) group".)
Subscribers log in hereLiterature review current through: Jul 2017. | This topic last updated: May 15, 2017.References
- Shimomura Y, Okumura K, Murayama SY, et al. Complete genome sequencing and analysis of a Lancefield group G Streptococcus dysgalactiae subsp. equisimilis strain causing streptococcal toxic shock syndrome (STSS). BMC Genomics 2011; 12:17.
- Davies MR, McMillan DJ, Beiko RG, et al. Virulence profiling of Streptococcus dysgalactiae subspecies equisimilis isolated from infected humans reveals 2 distinct genetic lineages that do not segregate with their phenotypes or propensity to cause diseases. Clin Infect Dis 2007; 44:1442.
- Vandamme P, Pot B, Falsen E, et al. Taxonomic study of lancefield streptococcal groups C, G, and L (Streptococcus dysgalactiae) and proposal of S. dysgalactiae subsp. equisimilis subsp. nov. Int J Syst Bacteriol 1996; 46:774.
- Jensen A, Kilian M. Delineation of Streptococcus dysgalactiae, its subspecies, and its clinical and phylogenetic relationship to Streptococcus pyogenes. J Clin Microbiol 2012; 50:113.
- Timoney JF. The pathogenic equine streptococci. Vet Res 2004; 35:397.
- Lacave G, Coutard A, Troché G, et al. Endocarditis caused by Streptococcus canis: an emerging zoonosis? Infection 2016; 44:111.
- Broyles LN, Van Beneden C, Beall B, et al. Population-based study of invasive disease due to beta-hemolytic streptococci of groups other than A and B. Clin Infect Dis 2009; 48:706.
- Schwartz IS, Keynan Y, Gilmour MW, et al. Changing trends in β-hemolytic streptococcal bacteremia in Manitoba, Canada: 2007-2012. Int J Infect Dis 2014; 28:211.
- 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.
- Pelkonen S, Lindahl SB, Suomala P, et al. Transmission of Streptococcus equi subspecies zooepidemicus infection from horses to humans. Emerg Infect Dis 2013; 19:1041.
- Rajasekhar A, Clancy CJ. Meningitis due to group C Streptococcus: a case report and review of the literature. Scand J Infect Dis 2010; 42:571.
- Bordes-Benítez A, Sánchez-Oñoro M, Suárez-Bordón P, et al. Outbreak of Streptococcus equi subsp. zooepidemicus infections on the island of Gran Canaria associated with the consumption of inadequately pasteurized cheese. Eur J Clin Microbiol Infect Dis 2006; 25:242.
- Barnham M, Thornton TJ, Lange K. Nephritis caused by Streptococcus zooepidemicus (Lancefield group C). Lancet 1983; 1:945.
- Francis AJ, Nimmo GR, Efstratiou A, et al. Investigation of milk-borne Streptococcus zooepidemicus infection associated with glomerulonephritis in Australia. J Infect 1993; 27:317.
- Kuusi M, Lahti E, Virolainen A, et al. An outbreak of Streptococcus equi subspecies zooepidemicus associated with consumption of fresh goat cheese. BMC Infect Dis 2006; 6:36.
- Galpérine T, Cazorla C, Blanchard E, et al. Streptococcus canis infections in humans: retrospective study of 54 patients. J Infect 2007; 55:23.
- Ohtaki H, Ohkusu K, Ohta H, et al. A case of sepsis caused by Streptococcus canis in a dog owner: a first case report of sepsis without dog bite in Japan. J Infect Chemother 2013; 19:1206.
- Lam MM, Clarridge JE 3rd, Young EJ, Mizuki S. The other group G Streptococcus: increased detection of Streptococcus canis ulcer infections in dog owners. J Clin Microbiol 2007; 45:2327.
- Brandt CM, Spellerberg B. Human infections due to Streptococcus dysgalactiae subspecies equisimilis. Clin Infect Dis 2009; 49:766.
- Loubinoux J, Plainvert C, Collobert G, et al. Adult invasive and noninvasive infections due to Streptococcus dysgalactiae subsp. equisimilis in France from 2006 to 2010. J Clin Microbiol 2013; 51:2724.
- Schugk J, Harjola VP, Sivonen A, et al. A clinical study of beta-haemolytic groups A, B, C and G streptococcal bacteremia in adults over an 8-year period. Scand J Infect Dis 1997; 29:233.
- Bradley SF, Gordon JJ, Baumgartner DD, et al. Group C streptococcal bacteremia: analysis of 88 cases. Rev Infect Dis 1991; 13:270.
- Carmeli Y, Schapiro JM, Neeman D, et al. Streptococcal group C bacteremia. Survey in Israel and analytic review. Arch Intern Med 1995; 155:1170.
- Auckenthaler R, Hermans PE, Washington JA 2nd. Group G streptococcal bacteremia: clinical study and review of the literature. Rev Infect Dis 1983; 5:196.
- Vartian C, Lerner PI, Shlaes DM, Gopalakrishna KV. Infections due to Lancefield group G streptococci. Medicine (Baltimore) 1985; 64:75.
- Venezio FR, Gullberg RM, Westenfelder GO, et al. Group G streptococcal endocarditis and bacteremia. Am J Med 1986; 81:29.
- Watsky KL, Kollisch N, Densen P. Group G streptococcal bacteremia. The clinical experience at Boston University Medical Center and a critical review of the literature. Arch Intern Med 1985; 145:58.
- Woo PC, Fung AM, Lau SK, et al. Group G beta-hemolytic streptococcal bacteremia characterized by 16S ribosomal RNA gene sequencing. J Clin Microbiol 2001; 39:3147.
- Sylvetsky N, Raveh D, Schlesinger Y, et al. Bacteremia due to beta-hemolytic Streptococcus group G: increasing incidence and clinical characteristics of patients. Am J Med 2002; 112:622.
- Cohen-Poradosu R, Jaffe J, Lavi D, et al. Group G streptococcal bacteremia in Jerusalem. Emerg Infect Dis 2004; 10:1455.
- Rantala S. Streptococcus dysgalactiae subsp. equisimilis bacteremia: an emerging infection. Eur J Clin Microbiol Infect Dis 2014; 33:1303.
- Ekelund K, Skinhøj P, Madsen J, Konradsen HB. Invasive group A, B, C and G streptococcal infections in Denmark 1999-2002: epidemiological and clinical aspects. Clin Microbiol Infect 2005; 11:569.
- Bucher A, Gaustad P. Septicemia and endocarditis caused by group G streptococci in a Norwegian hospital. Eur J Clin Microbiol Infect Dis 1990; 9:251.
- Rolston KV, Chandrasekar PH, LeFrock JL. Clinical features and antimicrobial therapy of infections caused by group G streptococci. Infection 1985; 13:203.
- Stein DS, Panwalker AP. Group C streptococcal endocarditis: case report and review of the literature. Infection 1985; 13:282.
- 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.
- Gaunt PN, Seal DV. Group G streptococcal infection of joints and joint prostheses. J Infect 1986; 13:115.
- Ortel TL, Kallianos J, Gallis HA. Group C streptococcal arthritis: case report and review. Rev Infect Dis 1990; 12:829.
- González Terán B, Roiz MP, Ruiz Jimeno T, et al. Acute bacterial arthritis caused by group C streptococci. Semin Arthritis Rheum 2001; 31:43.
- Bronze MS, Whitby S, Schaberg DR. Group G streptococcal arthritis: case report and review of the literature. Am J Med Sci 1997; 313:239.
- Baddour LM, Bisno AL. Non-group A beta-hemolytic streptococcal cellulitis. Association with venous and lymphatic compromise. Am J Med 1985; 79:155.
- Hilmarsdóttir I, Valsdóttir F. Molecular typing of Beta-hemolytic streptococci from two patients with lower-limb cellulitis: identical isolates from toe web and blood specimens. J Clin Microbiol 2007; 45:3131.
- Eriksson BK. Anal colonization of group G beta-hemolytic streptococci in relapsing erysipelas of the lower extremity. Clin Infect Dis 1999; 29:1319.
- Hashikawa S, Iinuma Y, Furushita M, et al. Characterization of group C and G streptococcal strains that cause streptococcal toxic shock syndrome. J Clin Microbiol 2004; 42:186.
- Hirose Y, Yagi K, Honda H, et al. Toxic shock-like syndrome caused by non-group A beta-hemolytic streptococci. Arch Intern Med 1997; 157:1891.
- Cohen D, Ferne M, Rouach T, Bergner-Rabinowitz S. Food-borne outbreak of group G streptococcal sore throat in an Israeli military base. Epidemiol Infect 1987; 99:249.
- Stryker WS, Fraser DW, Facklam RR. Foodborne outbreak of group G streptococcal pharyngitis. Am J Epidemiol 1982; 116:533.
- Gerber MA, Randolph MF, Martin NJ, et al. Community-wide outbreak of group G streptococcal pharyngitis. Pediatrics 1991; 87:598.
- Fox K, Turner J, Fox A. Role of beta-hemolytic group C streptococci in pharyngitis: incidence and biochemical characteristics of Streptococcus equisimilis and Streptococcus anginosus in patients and healthy controls. J Clin Microbiol 1993; 31:804.
- Hayden GF, Murphy TF, Hendley JO. Non-group A streptococci in the pharynx. Pathogens or innocent bystanders? Am J Dis Child 1989; 143:794.
- Tartof SY, Farrimond F, de Matos JA, et al. Inverse association between Lancefield group G Streptococcus colonization and sore throat in slum and nonslum settings in Brazil. J Clin Microbiol 2011; 49:409.
- Turner JC, Fox A, Fox K, et al. Role of group C beta-hemolytic streptococci in pharyngitis: epidemiologic study of clinical features associated with isolation of group C streptococci. J Clin Microbiol 1993; 31:808.
- Kirby R, Ruoff KL. Cost-effective, clinically relevant method for rapid identification of beta-hemolytic streptococci and enterococci. J Clin Microbiol 1995; 33:1154.
- Sunaoshi K, Murayama SY, Adachi K, et al. Molecular emm genotyping and antibiotic susceptibility of Streptococcus dysgalactiae subsp. equisimilis isolated from invasive and non-invasive infections. J Med Microbiol 2010; 59:82.
- Ergin A, Ercis S, Hasçelik G. In vitro susceptibility, tolerance and MLS resistance phenotypes of Group C and Group G streptococci isolated in Turkey between 1995 and 2002. Int J Antimicrob Agents 2003; 22:160.
- Ip M, Lyon DJ, Leung T, Cheng AF. Macrolide resistance and distribution of erm and mef genes among beta-haemolytic streptococci in Hong Kong. Eur J Clin Microbiol Infect Dis 2002; 21:238.
- Brown DF, Hope R, Livermore DM, et al. Non-susceptibility trends among enterococci and non-pneumococcal streptococci from bacteraemias in the UK and Ireland, 2001-06. J Antimicrob Chemother 2008; 62 Suppl 2:ii75.
- Biedenbach DJ, Toleman MA, Walsh TR, Jones RN. Characterization of fluoroquinolone-resistant beta-hemolytic Streptococcus spp. isolated in North America and Europe including the first report of fluoroquinolone-resistant Streptococcus dysgalactiae subspecies equisimilis: report from the SENTRY Antimicrobial Surveillance Program (1997-2004). Diagn Microbiol Infect Dis 2006; 55:119.