Invasive Group A Streptococcal Infections: T1M1 Isolates Expressing Pyrogenic Exotoxins A and B in Combination with Selective Lack of Toxin‐Neutralizing Antibodies Are Associated with Increased Risk of Streptococcal Toxic Shock Syndrome

Eriksson, B.; Andersson, Jan; Holm, Stig E.; Norgren, Mari

doi:10.1086/314872

Cited by 105 publications

(86 citation statements)

References 38 publications

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“…Interestingly, speA, the gene of a major superantigen often ascribed a role in severe GAS infections (6), was detected in these three strains but not in a number of noninvasive isolates. Since T28 has been a common type accounting for invasive disease in Sweden (23), it will be of interest to examine the M types of additional T28 invasive isolates.…”

Section: Discussionmentioning

confidence: 87%

Unusual Occurrence of M Type 77, Antibiotic-Resistant Group A Streptococci in Southern Sweden

et al. 2001

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For many years group A streptococci of T type 28 (T28) have been common in southern Sweden; however, since 1995 resistance to both macrolide-lincosamide-streptogramin B (MLS) antibiotics and tetracycline was observed among T28 isolates, which prompted the present studies on clonal relatedness of antibiotic-resistant T28 strains. By extended T typing, 95 of 100 examined tetracycline-resistant strains showed the combination T9-T13-T28; of these, 94 belonged to M type 77 (M77) and one belonged to M73. Three strains were T28-M28 and two were T28-M nontypeable. The serological M77 was confirmed by PCR capture enzyme-linked immunosorbent assay, emm amplicon restriction profiling, and emm sequence typing. Fifty strains were examined for superantigen genes: speA was detected in three blood isolates only, whereas all isolates harbored speB, and only two of the strains were negative for speC. Eighty-nine of the 100 strains were also macrolide resistant, of which 59 were inducibly MLS resistant (IR) and 21 were constitutively MLS resistant (CR), 6 were noninducibly resistant (NI), and 3 had novel subphenotypes recently reported by our group. Resistance genes were determined by PCR and hybridization methods. Eighty-four of the 100 strains harbored tetM. ermB was detected in all CR and IR strains, and mefA was found in all NI strains; both ermB and mefA were identified in two strains with novel subphenotypes. Pulsed-field gel electrophoresis showed that these antibiotic-resistant M77 strains belonged to at least five different clones.

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Section: Discussionmentioning

confidence: 87%

Unusual Occurrence of M Type 77, Antibiotic-Resistant Group A Streptococci in Southern Sweden

et al. 2001

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“…54 One study has shown a strong association between infection with strains possessing the SPEA gene and STSS. 55 These authors also documented two epidemic waves of genetically homogeneous T1M1 isolates associated with an increased risk of STSS. 55 Kaplan has postulated that virulence factors such as phage DNA may be transmitted to different GAS serotypes, thus explaining the serotypic diversity of isolates of GAS from patients with invasive infection.…”

Section: History Of Gas Infectionmentioning

confidence: 94%

“…[53][54][55] It is likely that both host factors, in terms of immunity, and bacterial factors are involved. 53,54 Host factors probably play a role in the severity of infection, as it has been demonstrated that the same strain of GAS may cause severe invasive disease, mild uncomplicated disease, or be present in a carrier state.…”

Section: History Of Gas Infectionmentioning

confidence: 99%

Severe group a streptococcal infection and streptococcal toxic shock syndrome

Baxter

McChesney

2000

Can J Anesth/J Can Anesth

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Purpose: To review the literature on group A streptococcal toxic shock syndrome, (STSS). Data source: Medline and EMBASE searches were conducted using the key words group A streptococcal toxic shock syndrome, alone and in combination with anesthesia; and septic shock, combined with anesthesia. Medline was also searched using key words intravenous immunoglobulin, (IVIG) and group A streptococcus, (GAS); and group A streptococcus and antibiotic therapy. Other references were included in this review if they addressed the history, microbiology, pathophysiology, incidence, mortality, presentation and management of invasive GAS infections. Relevant references from the papers reviewed were also considered. Articles on the foregoing topics were included regardless of study design. Non-English language studies were excluded. Literature on the efficacy of IVIG and optimal antibiotic therapy was specifically searched. Principal findings: Reports of invasive GAS infections have recently increased. Invasive GAS infection is associated with a toxic shock syndrome, (STSS), in 8 -14% of cases. The STSS characteristically results in shock and multi-organ failure soon after the onset of symptoms, and is associated with a mortality of 33 -81%. Many of these patients will require extensive soft tissue debridement or amputation in the operating room, on an emergency basis. The extent of tissue debridement required is often underestimated before skin incision. Conclusions: Management of STSS requires volume resuscitation, vasopressor/inotrope infusion, antibiotic therapy and supportive care in an intensive care unit, usually including mechanical ventilation. Intravenous immunoglobulin infusion has been recommended. Further studies are needed to define the role of IVIG in STSS management and to determine optimal anesthetic management of patients with septic shock.Objectif: Passer en revue la documentation sur le syndrome de choc toxique streptococcique de groupe A (SCTS). Sources: Des recherches ont été menées dans Medline et EMBASE en utilisant les mots-clés: group A streptococcal toxic shock syndrome, seul et en combinaison avec anesthesia; septic shock, combiné avec anesthesia. Dans Medline, nous avons aussi utilisé les entrées intravenous immunoglobulin (immunoblobuline intraveineuse, IGIV) et group A streptococcus (streptocoque du groupe A, SGA) et antibiotic therapy. Nous avons retenu d'autres références qui concernaient l'histoire, la microbiologie, la physiopathologie, l'incidence, la mortalité, la présenta-tion et le traitement des infections invasives de SGA. Les références pertinentes provenant des articles révisés ont aussi été conservées. Les articles concernant les sujets déjà cités ont été retenus sans tenir compte du type d'é-tude. On a exclu les études d'autres langues que l'anglais. La documentation sur l'efficacité de l'IGIV et sur l'antibiothérapie optimale a été spécialement recherchée. Constatations principales : Les articles sur les infections envahissantes de SGA ont récemment augmenté. L'infection invasive de ...

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“…During acute infection superantigens act as toxins that contribute to Streptococcal toxic shock like syndrome because they are triggers of exaggerated inflammation (Eriksson et al, 1999;Kotb, 1995;Sriskandan et al, 1996;Stevens et al, 1989;Yu and Ferretti, 1989). Moreover, they exert mitogenic activity on T-lymphocytes that may crucially influence the development of destructive autoimmunity in response to streptococcal infection.…”

Section: Streptococcal Factors In Arfmentioning

confidence: 99%