Clinical aspects of invasive infections with Streptococcus dysgalactiae ssp. equisimilis in Japan: differences with respect to Streptococcus pyogenes and Streptococcus agalactiae infections

Abstract

Streptococcus dysgalactiae ssp. equisimilis (SDSE) is increasingly being identified as a pathogen responsible for invasive and non-invasive infections. We compared the clinical features of invasive SDSE infections with those of invasive infections caused by Streptococcus pyogenes (group A streptococcus (GAS)) and Streptococcus agalactiae (group B streptococcus (GBS)). Active surveillance for invasive SDSE, GAS and GBS was maintained over 1 year at 142 medical institutions throughout Japan. Clinical information was collected together with isolates, which were characterized microbiologically. Two hundred and thirty-one invasive SDSE infections were identified, 97 other patients had infections with GAS, and 151 had infections with GBS. The median age of the SDSE patients was 75 years; 51% were male and 79% had underlying diseases. Forty-two SDSE patients (19%) presented to the emergency department. Among the 150 patients (65%) for whom follow-up was completed, 19 (13%) died and eight (5%) had post-infective sequelae (poor outcome). Insufficient white blood cell responses (<5000 cells/microL) and thrombocytopenia on admission each suggested significantly higher risk of poor outcome (ORs 3.6 and 4.5, respectively). Of 229 isolates, 55 (24%) showed an stG6792 emm type, which was significantly associated with poor outcome (OR 2.4). Clinical manifestations of invasive SDSE infections were distinct from those of invasive GBS infections. Primary-care doctors should consider invasive SDSE infections when treating elderly patients.

Eritrodermia con bacteriemia por Streptococcus dysgalactiae subespecie equisimilis en un paciente pediátrico: reporte de un caso y revisión de la literatura

“…Se aislaron 231 cepas de SDSE, ninguna de pacientes pediátricos. Al comparar la presentación con S. pyogenes y S. agalactiae, se encontró una diferencia estadísticamente significativa en la edad de presentación, siendo mayor en las infecciones por SDSE, con una mediana de 75 años 9 .…”

Group G streptococci mediate fibrinogen-dependent platelet aggregation leading to transient entrapment in platelet aggregates

“…Interestingly, despite the high homology between GGS and GAS (Watanabe et al, 2013;Takahashi et al, 2010), we report that GGS utilize a distinct mechanism to mediate platelet aggregation, whereby acquisition of fibrinogen alone is sufficient. We demonstrate that the platelet receptor for IgG is not required since platelet activation and aggregation occur despite blockade of this receptor in human blood, and in the absence of this receptor in mouse blood.…”

Soft tissue infection caused by Streptococcus dysgalactiae subsp. equisimilis possessing group Aantigen: a and review of the literature

“…Takahashi et al examined a group of isolates coming from invasive infections in Japan (2006-2007) (n = 231). mef(A) was present in 1.7%, erm(A) in 5.6%, and erm(B) in 2.6% of isolates [19,34].…”

“…The [11,16,62], patellar bursitis [57], appendicitis [4], salpingitis [22], abscesses of various locations [4,19,30,34], endocarditis [4,19,30,34,56,57], pyomyositis [21], gas gangrene [29,63], diabetic gangrene [12], and cystitis [31]. The SDSE may also cause non-invasive infections: cutaneous (impetigo [47,48]) and mucous (tonsillopharyngitis [2, 7,20,25,31,53,64], otitis media [2,40]).…”