Acute Group G Streptococcal Myositis Associated with Streptococcal Toxic Shock Syndrome: Case Report and Review

Wagner, John G.; Schlievert, Patrick M.; Assimacopoulos, A.; Stoehr, Jennifer A.; Carson, Paul J.; Komadina, Kevin H.

doi:10.1093/clinids/23.5.1159

Cited by 81 publications

(62 citation statements)

References 16 publications

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“…Individual cases of GCS and GGS invasive disease have been described before (28,29), but prospective surveillance has not been performed. Our data suggest that surveillance of invasive GAS disease in developing countries should also include surveillance of invasive GCS and GGS disease because the disease profi le of these organisms is similar and because control strategies, including vaccines that can offer cross-protection between Lancefi eld groups, may also be similar.…”

Section: Discussionmentioning

confidence: 99%

Prospective Surveillance of Invasive Group A Streptococcal Disease, Fiji, 2005–2007

Steer¹,

Jenney²,

Kado³

et al. 2009

Emerg. Infect. Dis.

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Section: Discussionmentioning

confidence: 99%

Prospective Surveillance of Invasive Group A Streptococcal Disease, Fiji, 2005–2007

Steer¹,

Jenney²,

Kado³

et al. 2009

Emerg. Infect. Dis.

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“…equisimilis strains having group A antigen rather than group C or G antigen have also been reported (Bert & Lambert-Zechovsky, 1997;Brandt et al, 1999;Katsukawa et al, 2002). Many recent studies have reported that this organism causes invasive and systemic streptococcal infections like GAS (Natoli et al, 1996;Wagner et al, 1996; Hirose et al, 1997; Kugi et al, 1998;Barnham et al, 2002;Cohen-Poradosu et al, 2004;Hashikawa et al, 2004). The organism has also been reported to cause a wide variety of human infections such as pharyngitis, cellulitis, sepsis, meningitis and endocarditis (Woo et al, 2001).…”

Section: Introductionmentioning

confidence: 97%

Molecular emm genotyping and antibiotic susceptibility of Streptococcus dysgalactiae subsp. equisimilis isolated from invasive and non-invasive infections

Sunaoshi

Murayama

Adachi

et al. 2010

Journal of Medical Microbiology

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To analyse the characteristics of infections caused by Streptococcus dysgalactiae subsp. equisimilis, clinical isolates (n5145) were collected at 11 medical institutions between September 2003 and October 2005. These isolates belonged to Lancefield group A (n55), group C (n518) or group G (n5122). Among all isolates, 42 strains were isolated from sterile samples such as blood, synovial fluid and tissue specimens from patients who were mostly over 50 years with invasive infections, and included seven cases of streptococcal toxic shock syndrome and necrotizing fasciitis. In contrast, the remaining 103 were isolated mainly from patients of all age groups with non-invasive infections such as pharyngotonsillitis. These isolates were classified into 25 types based on emm genotyping. A significant difference in emm types was observed between isolates from invasive and non-invasive infections (P,0.001): stG485, stG6792 and stG2078 predominated among isolates from invasive infections. A phylogenetic tree of complete open reading frames of emm genes in this organism showed high homology with those of Streptococcus pyogenes, but not with those of other streptococci. The presence of five different clones was estimated based on DNA profiles of isolates from invasive infections obtained by PFGE. Genes for resistance to macrolides [erm(A), three isolates; erm(B), five isolates; mef(A), seven isolates] and levofloxacin (mutations in gyrA and parC, four isolates) were identified in this organism. These results suggest the need for further nationwide surveillance of invasive infections caused by S. dysgalactiae subsp. equisimilis. INTRODUCTIONMost b-haemolytic streptococcal pathogens isolated from humans are identified as Streptococcus pyogenes (group A streptococci; GAS), Streptococcus agalactiae (group B streptococci; GBS), Streptococcus dysgalactiae subsp. equisimilis and species of the anginosus group that belong to Lancefield groups A, B, C, G or F (Facklam, 2002;Ruoff et al., 2003). In contrast to GAS and GBS, which are known to cause serious and systemic invasive infections, streptococci with Lancefield group C or G antigens were long considered to be commensal organisms that only rarely caused invasive infections as opportunistic pathogens.In 1996, S. dysgalactiae subsp. equisimilis was proposed as a new streptococcal taxon (Vandamme et al., 1996). Although rare, S. dysgalactiae subsp. equisimilis strains having group A antigen rather than group C or G antigen have also been reported (Bert & Lambert-Zechovsky, 1997;Brandt et al., 1999;Katsukawa et al., 2002 Notably, S. dysgalactiae subsp. equisimilis possesses many virulence factors shared with GAS, such as M protein (Fischetti, 1989; Schnitzler et al., 1995), streptolysin O (Gerlach et al., 1993Okumura et al., 1994), streptolysin S (Humar et al., 2002 and streptokinase (Walter et al., 1989;Ikebe et al., 2004). It has been suggested that these factors were transmitted from GAS to this species (Kalia et al., 2001).In the present report, we have described S. dysgalactiae ...

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“…Some of these bacteria cause various infections in domestic animals and, sometimes, in humans. Previous studies have demonstrated that none of these beta-hemolytic GCS and GGS secrete any major exotoxins (17,27,35,38,45,49). Unlike GAS-induced STSS, underlying conditions have been noted in most patients with STSS related to GCS and GGS.…”

mentioning

confidence: 99%

“…Recently, case reports referring to STSS caused by the Lancefield group C streptococci (GCS and G i and GGS, respectively) have also accumulated (1,2,11,14,17,24,27,30,35,38,45,49; H. Watanabe (ed. ), Rep. 24th Hyg.…”

mentioning

confidence: 99%

“…We performed epidemiological analyses with chromosomal pulsedfield gel electrophoresis (PFGE) and emm typing of these GCS and GGS strains. We further searched for the genes encoding superantigenic or mitogenic toxins, including a number of novel streptococcal exotoxins that are believed to express superantigenic or mitogenic activities (1,39,49), for more understanding of the pathogenesis of this rare, severe infection.…”

mentioning

confidence: 99%

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Characterization of Group C and G Streptococcal Strains That Cause Streptococcal Toxic Shock Syndrome

Hashikawa

Iinuma

Furushita³

et al. 2004

J Clin Microbiol

164

119

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Twelve strains (the largest number ever reported) of group C and G 1 streptococci (GCS and GGS, respectively) that caused streptococcal toxic shock syndrome (STSS) were collected and characterized. Eleven strains were identified as Streptococcus dysgalactiae subsp. equisimilis, and one strain was identified as Streptococcus equi subsp. zooepidemicus. We found that it was the first reported case of STSS caused by S. equi subsp. zooepidemicus. Cluster analysis according to the 16S rRNA gene (rDNA) sequences revealed that the S. dysgalactiae strains belonged to clusters I and II, both of which were closely related. The emm types and the restriction patterns of chromosomal DNA measured by pulsed-field gel electrophoresis were highly variable in these strains except BL2719 and N1434. The 16S rDNA sequences and other characteristics of these two strains were indistinguishable, suggesting the clonal dissemination of this particular S. dysgalactiae strain in Japan. As the involvement of superantigens in the pathogenesis of group A streptococcus-related STSS has been suggested, we tried to detect known streptococcal superantigens in GCS and GGS strains. However, only the spegg gene was detected in seven S. dysgalactiae strains, with none of the other superantigen genes being detected in any of the strains. However, the sagA gene was detected in all of the strains except Tokyo1291. In the present study no apparent factor(s) responsible for the pathogenesis of STSS was identified, although close genetic relationships of GCS and GGS strains involved in this disease were suggested.

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Acute Group G Streptococcal Myositis Associated with Streptococcal Toxic Shock Syndrome: Case Report and Review

Cited by 81 publications

References 16 publications

Prospective Surveillance of Invasive Group A Streptococcal Disease, Fiji, 2005–2007

Prospective Surveillance of Invasive Group A Streptococcal Disease, Fiji, 2005–2007

Molecular emm genotyping and antibiotic susceptibility of Streptococcus dysgalactiae subsp. equisimilis isolated from invasive and non-invasive infections

Characterization of Group C and G Streptococcal Strains That Cause Streptococcal Toxic Shock Syndrome

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