Necrotising fasciitis due to group A streptococci in western Norway: incidence and clinical features

Halstensen, Alfred; Chelsom, Julia; Haga, T.; Høiby, E. Arne

doi:10.1016/s0140-6736(94)90629-7

Cited by 219 publications

(177 citation statements)

References 18 publications

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“…It is now clear from our analysis that a complex multistep (9). Moreover, it has been well documented (2,3,5,7,8,11,12,14,19) that epidemic M1 infections occurred in Norway, Sweden, Finland, Denmark, Australia, and Canada in the ensuing years. The result of the genetic events we describe here was an explosive intercontinental epidemic of serotype M1 human infections including pharyngitis and severe invasive diseases such as necrotizing fasciitis, the "flesh-eating" infection.…”

Section: Concluding Commentmentioning

confidence: 70%

“…Group A Streptococcus (GAS, also known as Streptococcus pyogenes), a Gram-positive bacterial pathogen, causes human infections worldwide (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). For example, GAS is responsible for more than 600 million infections globally each year, including a conservative estimate of 10,000-15,000 severe invasive infections annually in the United States (4).…”

mentioning

confidence: 99%

“…This organism has a longrecognized proclivity to cause epidemic waves, the reasons for which are largely unknown. After several decades of declining incidence, a striking resurgence of severe invasive infections caused by serotype Emm protein 1 (M1) GAS was reported in many countries in the late 1980s and early 1990s (1)(2)(3)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). The resurgence received widespread public interest in part because of the untimely death of Jim Henson, the Muppeteer, of invasive GAS, and because of severe infections occurring in other notable public figures in Canada and elsewhere (21).…”

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confidence: 99%

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Evolutionary pathway to increased virulence and epidemic group A Streptococcus disease derived from 3,615 genome sequences

Nasser

Beres

Olsen

et al. 2014

Proc. Natl. Acad. Sci. U.S.A.

225

343

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We sequenced the genomes of 3,615 strains of serotype Emm protein 1 (M1) group A Streptococcus to unravel the nature and timing of molecular events contributing to the emergence, dissemination, and genetic diversification of an unusually virulent clone that now causes epidemic human infections worldwide. We discovered that the contemporary epidemic clone emerged in stepwise fashion from a precursor cell that first contained the phage encoding an extracellular DNase virulence factor (streptococcal DNase D2, SdaD2) and subsequently acquired the phage encoding the SpeA1 variant of the streptococcal pyrogenic exotoxin A superantigen. The SpeA2 toxin variant evolved from SpeA1 by a single-nucleotide change in the M1 progenitor strain before acquisition by horizontal gene transfer of a large chromosomal region encoding secreted toxins NAD + -glycohydrolase and streptolysin O. Acquisition of this 36-kb region in the early 1980s into just one cell containing the phage-encoded sdaD2 and speA2 genes was the final major molecular event preceding the emergence and rapid intercontinental spread of the contemporary epidemic clone. Thus, we resolve a decades-old controversy about the type and sequence of genomic alterations that produced this explosive epidemic. Analysis of comprehensive, population-based contemporary invasive strains from seven countries identified strong patterns of temporal population structure. Compared with a preepidemic reference strain, the contemporary clone is significantly more virulent in nonhuman primate models of pharyngitis and necrotizing fasciitis. A key finding is that the molecular evolutionary events transpiring in just one bacterial cell ultimately have produced millions of human infections worldwide.pathogenesis | phylogeography | mobile genetic element | flesh-eating disease | molecular clock

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Section: Concluding Commentmentioning

confidence: 70%

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confidence: 99%

mentioning

confidence: 99%

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Evolutionary pathway to increased virulence and epidemic group A Streptococcus disease derived from 3,615 genome sequences

Nasser

Beres

Olsen

et al. 2014

Proc. Natl. Acad. Sci. U.S.A.

225

343

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“…However, infections in limbs are usually due to a single microorganism arising from the skin fl ora such as Staphylococcus pyogenes. Recently, Group A streptococcal (GAS) infections have received much attention recently as aetiologic agents of NSTI [13][14][15][16][17]. Streptococcal NSTIs can occur in otherwise healthy people at any age and may cause rapid onset of shock and multiple-organ failure [18].…”

Section: Pseudomonas Aeruginosamentioning

confidence: 99%

Integrated clinical care pathway for managing necrotising soft tissue infections

et al. 2009

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“…Progression may therefore involve bacterial dissemination via lymphatics and/or diffusion of bacterial cytotoxins through lymphatics or along tissue planes, with tissue death occurring ahead of bacterial colonization. Local tissue necrosis is frequently accompanied by severe systemic manifestations of toxaemia, including hypotension, impaired renal function and disordered blood coagulation [13]. The systemic symptoms are similar to those of the streptococcal toxic shock-like syndrome [14].…”

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confidence: 99%

A cluster of cases of streptococcal necrotizing fasciitis in Gloucestershire

et al. 1995

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SUMMARYWe describe the first cluster of cases of necrotizing fasciitis (NF) in this century in the United Kingdom (UK). Between 1 January and 30 June 1994 there were six cases (five confirmed, one probable) of Streptococcus pyogenes NF in west Gloucestershire, population 320000. Two cases died. The first two patients probably acquired their infections during the course of elective surgery performed in the same operating theatre, possibly from a nasopharyngeal carrier amongst the theatre staff. The remaining infections were community-acquired. Of 5 S. pyogenes isolates there were 2 MI strains, 1 M3, 1 M5 and 1 M non-typeable strain. S. pyogenes NF had not been recorded in west Gloucestershire in the preceding 10 years and the incidence of S. pyogenes bacteraemia in England and Wales had not risen in the past 5 years.The two presumably theatre-acquired infections raised several issues. The need for detailed bacteriological investigation of all cases of post-surgical NF was confirmed. Clusters of S. pyogene8 infection following surgery should be managed by closure of the operating theatre until all staff have been screened for carriage. Closure of an operating theatre and screening of staff following a sporadic case is probably not justified because of the infrequency of surgical cross-infection with S. pyogenes. Regular. routine screening of theatre staff is neither practical nor necessary.

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Necrotising fasciitis due to group A streptococci in western Norway: incidence and clinical features

Cited by 219 publications

References 18 publications

Evolutionary pathway to increased virulence and epidemic group A Streptococcus disease derived from 3,615 genome sequences

Evolutionary pathway to increased virulence and epidemic group A Streptococcus disease derived from 3,615 genome sequences

Integrated clinical care pathway for managing necrotising soft tissue infections

A cluster of cases of streptococcal necrotizing fasciitis in Gloucestershire

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