Associations between common respiratory viruses and invasive group A streptococcal infection: A time‐series analysis

Abstract

Background Invasive infections by group A S treptococcus (iGAS, Streptococcus pyogenes ) have a winter seasonality which largely coincides with the season for influenza and other respiratory viruses. Influenza superinfections with GAS have been described to occur regularly and to show a severe clinical picture with high mortality. We aimed to study the extent to which influenza A and B viruses (IAV and IBV), respiratory syncytial virus (RSV) and rhinovirus circulation contribute to iGAS incidence and severity. Methods Time‐series regression models were built to explore the temporal associations between weekly laboratory counts of IAV, IBV, RSV and rhinovirus as independent variables and weekly counts of GAS disease notifications or laboratory GAS cultures as dependent variables. Results The weekly number of IAV detections showed a significant temporal association with the number of notifications of streptococcal toxic shock syndrome (STSS), a severe complication of iGAS. Depending on the season, up to 40% of all notified STSS cases was attributable to IAV circulation. Besides STSS, none of the other iGAS manifestations were associated with a respiratory virus. Conclusions Our study found an ecological temporal association between IAV and STSS, the most severe complication of iGAS. Future studies are needed to confirm this association and assess the possible preventability of STSS by influenza vaccination, especially in the age group 60 years and older.

Increasing Incidence of Invasive Group A Streptococcus Disease, Idaho, USA, 2008–2019

“…We observed 10 different emm types among STSS cases that had an isolate submitted for typing, indicating a lack of clonality. Of note, a study in the Netherlands identified a temporal association between STSS and influenza A virus ( 27 ). However, STSS cases in Idaho occurred throughout the year, without seasonal patterns that might have been associated with influenza.…”

Streptococcus pyogenescolonization in children aged 24-59 months in The Gambia: Impact of Live Attenuated Influenza Vaccine and associated serological responses

“…pyogenes disease, their role in modulating the host-pathogen interaction is complex and poorly understood, particularly in relation to colonization of the pharynx [8,9,[18][19][20][21]. As respiratory viruses frequently infect the colonizing sites of bacteria, it is important to understand their impact on potentially pathogenic bacteria such as S. pyogenes.…”

Secondary streptococcal infection following influenza

“…93 Clinically, S. pyogenes infections secondary to influenza are often accompanied by pneumonia, septicemia, and necrotizing fasciitis. 7,[94][95][96] Microbiological studies of lung tissue and blood culture samples from the Spanish influenza pandemic suggested that S. pyogenes as well as S. pneumoniae and S. aureus were the most common related pathogens, and responsible for the majority of lethal courses. 4,31 Furthermore, a time-series analysis of case reports revealed an ecological temporal association (up to 40%) between IAV and toxic shock syndrome, a severe complication of S. pyogenes infection.…”

“…4,31 Furthermore, a time-series analysis of case reports revealed an ecological temporal association (up to 40%) between IAV and toxic shock syndrome, a severe complication of S. pyogenes infection. 94…”

“…Clinically, S. pyogenes infections secondary to influenza are often accompanied by pneumonia, septicemia, and necrotizing fasciitis 7,94–96 . Microbiological studies of lung tissue and blood culture samples from the Spanish influenza pandemic suggested that S. pyogenes as well as S. pneumoniae and S. aureus were the most common related pathogens, and responsible for the majority of lethal courses 4,31 .…”