Spectrum of disease in bacteraemic patients during aStreptococcus pyogenes serotype M-1 epidemic in Norway in 1988

Abstract

All 87 known cases of bacteraemia due to Streptococcus pyogenes (beta-haemolytic group A streptococci) occurring during the peak of a nationwide outbreak in Norway (population 4.2 million) between January and June 1988 were reviewed. Clinical features varied widely and appeared largely to be dependent on the patients' age. The case fatality rate ranged from 11% in the age group under 30 years to 44% in patients over 60 years. Clinical complications such as shock, severe renal or respiratory failure or serious local infection occurred particularly in 30-to 59-year old individuals. Shock was manifest in 32% of the patients and carried a 68% case fatality rate. Chronic heart disease in the elderly and pneumonia seemed to be associated with a fatal outcome. In the 25 patients (29%) who died the disease showed a fulminant course, 80% dying within 48 hours after admission. However, 56% of the patients had experienced symptoms for more than two days before admission, suggesting that early diagnosis and treatment might possibly have prevented the development of a serious disease. This study revealed a wide spectrum of clinical manifestations in bacteraemia cases in a unique epidemiological situation caused largely by a single serotype of Streptococcus pyogenes; 89% of the 27 preserved bacteraemia strains carried the M-1 antigen. The observations call attention to the ability of these organisms to cause fulminant clinical illness, indicating a probable increase in both invasiveness and toxicity of group A streptococci responsible for the epidemic.

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

“…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.…”

“…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).…”

“…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).…”

Streptococcus pyogenes Isolates Causing Severe Infections in Norway in 2006 to 2007: emm Types, Multilocus Sequence Types, and Superantigen Profiles

“…Norway experienced relatively low incidence rates of severe GAS disease after the introduction of antibiotics, but in the mid-1980s there was an increased occurrence of severe invasive disease, especially in otherwise healthy young adults, largely caused by M-1 strains (9,33). Thereafter, until the early 2000s, there was a significant decrease in the frequency of emm-1 strains and, at the same time, an increase in diversity among the Norwegian GAS strains (37).…”

Invasive group A streptococcal infections in childhood: Experience in North Yorkshire

“…Reported case series and surveys of serious group A streptococcal (GAS) infection [1][2][3][4][5][6][7][8][9][10][11][12][13] have usually included some childhood infections as part of the spectrum encountered, but there have been relatively few studies reporting more specifically on this age group [14][15][16][17][18][19][20]. Over many years we have accumulated a database of local cases of invasive GAS infection in patients of all ages for study.…”