Invasive group A streptococcal infections in adults, France (2006–2010)

Plainvert, Céline; Doloy, Alexandra; Loubinoux, Julien; Lepoutre, A.; Collobert, Gislène; Touak, Gérald; Trieu-Cuot, Patrick; Bouvet, Anne; Poyart, Claire

doi:10.1111/j.1469-0691.2011.03624.x

Cited by 111 publications

(76 citation statements)

References 40 publications

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“…Finally, GAS strains detected from respiratory and osteoarticular samples were predominantly emm type 1. Plainvert et al described such an association for respiratory samples only (with the emm type predominant in septic arthritis being emm 28), but the limited number of osteoarticular samples in this study may restrict our interpretation regarding emm distribution (18).…”

Section: Discussionmentioning

confidence: 58%

“…Because RADTs were developed for diagnosing pharyngitis, we aimed to characterize the emm types implicated in this study. emm 1, emm 89, and emm 12 have been the most frequently identified sequence types described in invasive infections in Europe, the United States, and Australia (18)(19)(20). Nonetheless, the increased prevalence of emm type 28 strains was not observed in our study.…”

Section: Discussionmentioning

confidence: 99%

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Reassessment of the Role of Rapid Antigen Detection Tests in Diagnosis of Invasive Group A Streptococcal Infections

et al. 2016

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i Rapid antigen detection tests (RADTs) for group A streptococci (GAS) are widely used for diagnosing acute pharyngitis, which has led to a considerable reduction in antibiotic prescriptions over the past decade. Beyond this intended use, their reassessment on invasive samples may be relevant in the management of life-threatening GAS infections. To this end, we evaluated the performances of three RADTs, culture, GAS PCR, and 16S rRNA gene PCR assays, and compared them with a composite gold standard (GAS-PCR assay and/or culture) for the diagnosis of severe GAS infection. A total of 192 specimens from deep-tissue (mostly normally sterile) sites enriched for 75 GAS-positive samples were enrolled in the study. The three evaluated RADTs showed sensitivities ranging from 88.0% to 94.7% versus 98.7% for GAS PCR, 84% for 16S rRNA gene PCR, and 77.3% for culture. The sensitivities of the ImmunoCard STAT! Strep A test (Meridian Bioscience) and the NADAL Strep A strip (Nal Von Minden) were similar to that of GAS PCR (P ‫؍‬ 0.25 and 0.03, respectively) and higher than that of culture (P ‫؍‬ 0.001 and 0.006, respectively), whereas the SD Bioline Strep A test strip (Standard Diagnostics) showed a performance similar to that of culture (P ‫؍‬ 0.02). The three RADTs detected 10 distinct emm types, including a predominance of emm 1 (33.3%), emm 89 (10.6%), and emm 12 (7.6%). No false-positive results were observed, leading to a specificity of 100% for all the evaluated RADTs. The GAS RADTs turned out to be sensitive, specific, and easy-to-use tools that may aid in the management of invasive GAS infections in 24/7 point-of-care laboratories by enabling early diagnosis and focused therapy. Group A streptococci (GAS) are common bacterial pathogens responsible for mild diseases, such as pharyngitis, and invasive and life-threatening infections resulting from their dissemination into deep tissues. The worrying increase in the prevalence of these severe infections and their high fatality rates emphasize the need for rapid diagnostic tests to aid in patient management (1, 2).Over the past 2 decades, manufacturers have developed immunochromatographic rapid antigen detection tests (RADTs) that detect the polysaccharide C cell-wall antigen of bacteria. These tests are now widely used for diagnosing pharyngitis in pediatric outpatient clinics and private practices, which has considerably reduced the number of antibiotic prescriptions and resulted in fewer throat cultures performed by laboratories (3-5).Extending their indication beyond this intended use, namely, on deep-seated samples, may reduce delays in the diagnosis of invasive infections. To this end, we evaluated the performances of three commercially available RADTs approved for pharyngitis in the diagnosis of invasive GAS infections and compared them with those of conventional culture and molecular techniques. MATERIALS AND METHODSPatients and clinical specimens. This survey was conducted by three teaching hospitals (in Lyon, Grenoble, and Saint-Etienne, France) between May 2013 a...

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Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Reassessment of the Role of Rapid Antigen Detection Tests in Diagnosis of Invasive Group A Streptococcal Infections

et al. 2016

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“…The global distribution of the emm genotypes is variable by continents and also in time (7,8). Moreover, variations are observed between countries of the same continent reflecting ongoing epidemic waves, herd immunity, or population immunity (9)(10)(11)(12).…”

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confidence: 99%

Molecular Epidemiology of sil Locus in Clinical Streptococcus pyogenes Strains

et al. 2014

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Streptococcus pyogenes (group A Streptococcus [GAS]) causes a wide variety of diseases, ranging from mild noninvasive to severe invasive infections. Mutations in regulatory components have been implicated in the switch from colonization to invasive phenotypes. The inactivation of the sil locus, composed of six genes encoding a quorum-sensing complex, gives rise to a highly invasive strain. However, studies conducted on limited collections of GAS strains suggested that sil prevalence is around 15%; furthermore, whereas a correlation between the presence of sil and the genetic background was suggested, no link between the presence of a functional sil locus and the invasive status was assessed. We established a collection of 637 nonredundant strains covering all emm genotypes present in France and of known clinical history; 68%, 22%, and 10% were from invasive infections, noninvasive infections, and asymptomatic carriage, respectively. Among the 637 strains, 206 were sil positive. The prevalence of the sil locus varied according to the emm genotype, being present in >85% of the emm4, emm18, emm32, emm60, emm87, and emm90 strains and absent from all emm1, emm28, and emm89 strains. A random selection based on 2009 French epidemiological data indicated that 16% of GAS strains are sil positive. Moreover, due to mutations leading to truncated proteins, only 9% of GAS strains harbor a predicted functional sil system. No correlation was observed between the presence or absence of a functional sil locus and the strain invasiveness status.

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confidence: 99%

“…emm4 and emm89 GAS strains are responsible for invasive infections and have already been isolated from endometritis and puerperal infections (8,9). Moreover, emm89 is the third most prevalent emm type accounting for invasive infections in Europe, emm1 and emm28 being the first and the second, respectively (8,9). Apart from strains belonging to emm1 and emm3, which are clearly more associated with streptococcal toxic shock syndrome, and emm28, which are overrepresented among S. pyogenes isolated from genital infections, there is no clear correlation between an emm genotype and a given infectious presentation.…”

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confidence: 99%