Age-related differences in clinical characteristics of invasive group G streptococcal infection: Comparison with group A and group B streptococcal infections

Abstract

Purpose Invasive Group G streptococcal infection (iGGS) has increasingly been recognized as a cause of severe disease, mainly among elderly people with chronic illnesses. This study aimed to examine age-related differences in clinical characteristics of iGGS and describe its characteristics among very elderly individuals (≥80 years). Methods Fifty-four iGGS patients for whom detailed clinical information was available were identified from 2002 to 2014 in a tertiary care hospital in Japan. iGGS (n = 54) was compared with invasive Group A (iGAS; n = 17) and B streptococcal infection patients (iGBS; n = 52) based on patient age. Results The incidence of iGGS in our catchment area significantly increased during the study period. The prevalence of iGGS in the very elderly population was higher than that of iGAS or iGBS (p<0.001). Among iGGS patients, cardiovascular disease, chronic kidney disease, oxygen demand, and bacteremia with unknown focus of infection were more frequent in the very elderly population (p = 0.009, p = 0.02, p = 0.04, and p = 0.04, respectively). Altered mental status was present in half of iGGS patients aged ≥60 years (p = 0.03). In contrast, alcohol drinking and liver cirrhosis were significantly more frequent in patients with iGGS aged <60 years than in other age groups (p<0.001, p = 0.001, respectively). Levofloxacin resistance in GBS isolates was significantly more frequent among very elderly patients than among other age groups (p<0.001). Conclusions The burden of iGGS has been increasing in our catchment area. Different iGGS-associated clinical characteristics were found in each age group. Unclear and atypical clinical manifestations and syndromes were likely to be observed in very elderly patients. Alcohol drinking and liver cirrhosis may contribute to iGGS even in patients aged <60 years. Understanding these age-related differences could be helpful for optimal diagnosis and treatment.

Necrotizing fasciitis and septic shock due to streptococcal toxic shock syndrome in an elderly patient: A case report

“…Among GGS, SDSE infection is most frequent in humans [5]. While STSS due to GAS can occur in patients without underlying conditions [6], STSS due to GGS tends to occur in elderly patients and those with underlying conditions, such as diabetes mellitus, cardiovascular diseases, malignancies, cirrhosis, immunosuppressive conditions, or skin diseases [5,7,8]. In our case, the causative bacterium of STSS was not GAS, but SDSE of GGS.…”

Burden of invasive group B Streptococcus disease in non-pregnant adults: A systematic review and meta-analysis

“…Nineteen studies reported information on antimicrobial susceptibility testing. In fifteen of them, all tested isolates were 100% susceptible to penicillin [ 2 , 22 , 24 , 28 , 31 , 36 , 40 , 42 – 44 , 46 , 47 , 51 , 54 , 55 ]. Four studies reported some resistance to penicillin [ 23 , 27 , 30 , 35 ], at 2%, 1.4%, 0.5%, and 2%, respectively ( S5 Table ).…”

Invasive Infections Caused by Lancefield Groups C/G and A Streptococcus, Western Australia, Australia, 2000–2018

“…For the few settings where comparative epidemiologic data are available, the incidence of iGCGS infection is similar or higher than for invasive GAS (10,11). Also shared in common with invasive GAS infections, iGCGS has a death rate of 5%-10%, and its incidence appears to be increasing in recent years in some countries (10,(12)(13)(14).In a recent study, we demonstrated an increasing incidence of invasive GAS infection that disproportionately affects Indigenous Australians (15). By using this same methodology, we sought to describe the epidemiology of iGCGS infection in terms of incidence, median length of hospital stay, and all-cause deaths and to compare these metrics with those in patients with invasive GAS infections.…”

“…Unlike GAS, which is notifiable in many jurisdictions, such as the United Kingdom (8) and Canada (9), iGCGS is not considered a notifiable disease in any jurisdiction. For the few settings where comparative epidemiologic data are available, the incidence of iGCGS infection is similar or higher than for invasive GAS (10,11). Also shared in common with invasive GAS infections, iGCGS has a death rate of 5%-10%, and its incidence appears to be increasing in recent years in some countries (10,(12)(13)(14).…”

“…For the few settings where comparative epidemiologic data are available, the incidence of iGCGS infection is similar or higher than for invasive GAS (10,11). Also shared in common with invasive GAS infections, iGCGS has a death rate of 5%-10%, and its incidence appears to be increasing in recent years in some countries (10,(12)(13)(14).…”