Increasing Incidence of Invasive Group A Streptococcus Disease in First Nations Population,Alberta, Canada, 2003–2017

The incidence of invasive group A Streptococcus (iGAS) disease in the general population in Alberta, Canada, has been steadily increasing. To determine whether rates for specific populations such as First Nations are also increasing, we investigated iGAS cases among First Nations persons in Alberta during 2003–2017. We identified cases by isolating GAS from a sterile site and performing emm typing. We collected demographic, social, behavioral, and clinical data for patients. During the study period, 669 cases of iGAS in First Nations persons were reported. Incidence increased from 10.0 cases/100,000 persons in 2003 to 52.2 cases/100,000 persons in 2017. The 2017 rate was 6 times higher for the First Nations population than for non–First Nations populations (8.7 cases/100,000 persons). The 5 most common emm types from First Nations patients were 59, 101, 82, 41, and 11. These data indicate that iGAS is severely affecting the First Nations population in Alberta, Canada.     

Hypervirulent emm59 Clone in Invasive Group A Streptococcus Outbreak,Southwestern United States

The hyper-virulent emm59 genotype of invasive group A Streptococcus was identified in northern Arizona in 2015. Eighteen isolates belonging to a genomic cluster grouped most closely with recently identified isolates in New Mexico. The continued transmission of emm59 in the southwestern United States poses a public health concern.     

Spread of Virulent Group A Streptococcus Type emm59 from Montana to Wyoming,USA

Full-genome sequencing showed that a recently emerged and hypervirulent clone of group A Streptococcus type emm59 active in Canada and parts of the United States has now caused severe invasive infections in rural northeastern Wyoming. Phylogenetic analysis of genome data indicated that the strain was likely introduced from Montana.     

Genomic analysis of emm59 group A Streptococcus invasive strains, United States

Genomic analysis of type emm59 group A Streptococcus invasive strains isolated in the United States discovered higher than anticipated genetic heterogeneity among strains and identified a heretofore unrecognized monoclonal cluster of invasive infections in the San Francisco Bay area. Heightened monitoring for a potential shift in the epidemic behavior of emm59 group A Streptococcus is warranted.     

儿童A群链球菌感染的耐药性分析及其emm基因分型

[目的]了解广州地区儿童感染 A 群链球菌(GAS)的耐药情况及emm基因分型. [方法]对所分离的GAS以K-B法进行药敏试验并分析耐药情况;采用PCR法扩增GAS的M蛋白N末端,直接进行测序确定GAS的emm基因分型. [结果]GAS对青霉素、阿莫西林/棒酸、氧氟沙星、头孢菌素和万古霉素敏感.对红霉素、克林霉素、复方新诺明、四环素和氯霉素的耐药率分别为47.1%、42.5%、33.3%、21.8%、18.4%.以emm1基因型为主(37.9%),其次为emm18(13.8%),emm12(11.5%),emm69(9.2%)等. [结论]广州地区儿童感染GAS对大环内酯类等抗菌药物耐药形势严峻,应引起重视;GAS的emm基因型主要为emm1,选择主要流行菌株,可以作为基因疫苗的基础.     

猩红热患儿A族链球菌emm基因分型及地域与毒力基因分布相关研究

 目的 探讨猩红热儿童分离来源的A族链球菌（GAS）emm分型、地域与毒力基因分布的相关性。方法 采集北京和上海地区猩红热患儿标本进行GAS分离鉴定,应用聚合酶链式反应（PCR）方法检测emm基因型以及13种毒力基因（speA、speB、speC、speF、speG、speH、speI、speJ、speK、speL、speM、ssa和smeZ）携带情况,分析GAS菌株毒力基因分布与地域、emm基因型的关系。结果 114株GAS分离株中,emm1.0型60株,emm12.0型54株;52株分离自北京（emm1.0型31株,emm12.0型21株）,62株分离自上海（emm1.0型29株,emm12.0型33株）。speA、speC、speG、speH、speI、speJ、speK、ssa和smeZ基因携带率分别为52.6％、76.3％、80.7％、43.9％、55.3％、57.0％、75.4％、97.4％、93.0％,speB和speF携带率均为98.2%,未检出speL、speM基因。北京地区emm1.0型与emm12.0 GAS菌株speA、speH、speI和speJ基因携带率比较,上海地区emm1.0型与emm12.0 GAS菌株speA、speH、speI、speJ和speK基因携带率比较,差异均有统计学意义（均P<0.05）。emm1.0型GAS菌株speC、speH、speJ和speK基因携带率北京与上海两地区比较,差异均有统计学意义（均P<0.05）,emm12.0型GAS菌株speC、speH、speI、speJ和speK基因北京与上海两地区比较,差异均有统计学意义（均P<0.05）。结论 GAS菌株毒力基因的分布状态因emm基因分型及地域不同存在差异。     

Characteristics of Group A Streptococcus Strains Circulating during Scarlet Fever Epidemic,Beijing, China, 2011

Scarlet fever is one of a variety of diseases caused by group A Streptococcus (GAS). During 2011, a scarlet fever epidemic characterized by peak monthly incidence rates 2.9–6.7 times higher than those in 2006–2010 occurred in Beijing, China. During the epidemic, hospital-based enhanced surveillance for scarlet fever and pharyngitis was conducted to determine characteristics of circulating GAS strains. The surveillance identified 3,359 clinical cases of scarlet fever or pharyngitis. GAS was isolated from 647 of the patients; 76.4% of the strains were type emm12, and 17.1% were emm1. Almost all isolates harbored superantigens speC and ssa. All isolates were susceptible to penicillin, and resistance rates were 96.1% to erythromycin, 93.7% to tetracycline, and 79.4% to clindamycin. Because emm12 type GAS is not the predominant type in other countries, wider surveillance for the possible spread of emm12 type GAS from China to other countries is warranted.     

Rapidly Fatal Hemorrhagic Pneumonia and Group A Streptococcus Serotype M1

We report 3 cases of fulminant hemorrhagic pneumonia in previously health patients. Sudden-onset hemoptysis and dyspnea developed; all 3 patients and died <12 h later of massive pulmonary bleeding, despite aggressive supportive care. Postmortem analysis showed that the illnesses were caused by group A Streptococcus emm1/sequence type 28 strains.     

Increasing Incidence of Invasive Group A Streptococcus Disease,Idaho, USA, 2008–2019

We investigated invasive group A Streptococcus epidemiology in Idaho, USA, during 2008–2019 using surveillance data, medical record review, and emm (M protein gene) typing results. Incidence increased from 1.04 to 4.76 cases/100,000 persons during 2008–2019. emm 1, 12, 28, 11, and 4 were the most common types, and 2 outbreaks were identified. We examined changes in distribution of clinical syndrome, patient demographics, and risk factors by comparing 2008–2013 baseline with 2014–2019 data. Incidence was higher among all age groups during 2014–2019. Streptococcal toxic shock syndrome increased from 0% to 6.4% of cases (p = 0.02). We identified no differences in distribution of demographic or risk factors between periods. Results indicated that invasive group A Streptococcus is increasing among the general population of Idaho. Ongoing surveillance of state-level invasive group A Streptococcus cases could help identify outbreaks, track regional trends in incidence, and monitor circulating emm types.     

Epidemiology of Streptococcus dysgalactiae subsp. equisimilis in tropical communities, Northern Australia

Streptococcus dysgalactiae subsp. equisimilis (groups C and G streptococci [GCS/GGS]) is an increasingly recognized human pathogen, although it may follow indirect pathways. Prospective surveillance of selected households in 3 remote Aboriginal communities in Australia provided 337 GCS/GGS isolates that were emm sequence-typed. Lancefield group C isolates (GCS) were localized to specific households and group G isolates (GGS) were more evenly distributed. GCS/GGS was more frequently recovered from the throat than group A streptococci (GAS [S. pyogenes]) but rarely recovered from skin sores, and then only with Staphylococcus aureus or GAS. Symptomatic GGS/GGC pharyngitis was also rare. Specific emm sequence types of GCS/GGS did not appear to cycle through the communities (sequential strain replacement) in a manner suggesting acquisition of type-specific immunity. These communities already have high levels of streptococcal and poststreptococcal disease. GCS/GGS may increase in importance as it acquires key virulence factors from GAS by lateral gene transfer.     

Population Structure and Antimicrobial Resistance of Invasive Serotype IV Group B Streptococcus,Toronto, Ontario,Canada

We recently showed that 37/600 (6.2%) invasive infections with group B Streptococcus (GBS) in Toronto, Ontario, Canada, were caused by serotype IV strains. We report a relatively high level of genetic diversity in 37 invasive strains of this emerging GBS serotype. Multilocus sequence typing identified 6 sequence types (STs) that belonged to 3 clonal complexes. Most isolates were ST-459 (19/37, 51%) and ST-452 (11/37, 30%), but we also identified ST-291, ST-3, ST-196, and a novel ST-682. We detected further diversity by performing whole-genome single-nucleotide polymorphism analysis and found evidence of recombination events contributing to variation in some serotype IV GBS strains. We also evaluated antimicrobial drug resistance and found that ST-459 strains were resistant to clindamycin and erythromycin, whereas strains of other STs were, for the most part, susceptible to these antimicrobial drugs.     

Invasive Group A Streptococcus Infection among Children,Rural Kenya

To determine the extent of group A Streptococcus (GAS) infections in sub-Saharan Africa and the serotypes that cause disease, we analyzed surveillance data for 64,741 hospital admissions in Kilifi, Kenya, during 1998–2011. We evaluated incidence, clinical presentations, and emm types that cause invasive GAS infection. We detected 370 cases; of the 369 for which we had data, most were skin and soft tissue infections (70%), severe pneumonia (23%), and primary bacteremia (14%). Overall case-fatality risk was 12%. Incidence of invasive GAS infection was 0.6 cases/1,000 live births among neonates, 101/100,000 person-years among children <1 year of age, and 35/100,000 among children <5 years of age. Genome sequencing identified 88 emm types. GAS causes serious disease in children in rural Kenya, especially neonates, and the causative organisms have considerable genotypic diversity. Benefit from the most advanced GAS type–specific vaccines may be limited, and efforts must be directed to protect against disease in regions of high incidence.     

Antimicrobial Drug Use and Macrolide-Resistant Streptococcus pyogenes, Belgium

In Belgium, decreasing macrolide, lincosamide, streptogramins B, and tetracycline use during 1997-2007 correlated significantly with decreasing macrolide-resistant Streptococcus pyogenes during 1999-2009. Maintaining drug use below a critical threshold corresponded with low-level macrolide-resistant S. pyogenes and an increased number of erm(A)-harboring emm77 S. pyogenes with low fitness costs.     

Group B Streptococcus and HIV infection in pregnant women, Malawi, 2008-2010

To determine whether an association exists between group B streptococcus carriage and HIV infection, we recruited 1,857 pregnant women (21.7% HIV positive) from Queen Elizabeth Central Hospital, Blantyre, Malawi. Overall, group B streptococcus carriage was 21.2% and did not differ by HIV status. However, carriage was increased among HIV-positive women with higher CD4 counts.     

Invasive group A streptococcal infection and vaccine implications, Auckland, New Zealand

We aimed to assess the effect of invasive group A streptococcal (GAS) infection and the potential effects of a multivalent GAS vaccine in New Zealand. During January 2005-December 2006, we conducted prospective population-based laboratory surveillance of Auckland residents admitted to all public hospitals with isolation of GAS from normally sterile sites. Using emm typing, we identified 225 persons with confirmed invasive GAS infection (median 53 years of age; range 0-97 years). Overall incidence was 8.1 cases per 100,00 persons per year (20.4/100,000/year for Maori and Pacific Islanders; 24.4/100,000/year for persons >65 years of age; 33/100,000/year for infants <1 year of age). Nearly half (49%) of all cases occurred in Auckland's lowest socioeconomic quintile. Twenty-two persons died, for an overall case-fatality rate of 10% (63% for toxic shock syndrome). Seventy-four percent of patients who died had an underlying condition. To the population in our study, the proposed 26-valent vaccine would provide limited benefit.     

Intestinal toxemia botulism in 3 adults, Ontario, Canada, 2006-2008

Five cases of intestinal toxemia botulism in adults were identified within an 18-month period in or near Toronto, Ontario, Canada. We describe findings for 3 of the 5 case-patients. Clinical samples contained Clostridium botulinum spores and botulinum neurotoxins (types A and B) for extended periods (range 41-61 days), indicative of intestinal toxemia botulism. Patients' clinical signs improved with supportive care and administration of botulinum antitoxin. Peanut butter from the residence of 1 case-patient yielded C. botulinum type A, which corresponded with type A spores found in the patient's feces. The food and clinical isolates from this case-patient could not be distinguished by pulsed-field gel electrophoresis. Two of the case-patients had Crohn disease and had undergone previous bowel surgery, which may have contributed to infection with C. botulinum. These cases reinforce the view that an underlying gastrointestinal condition is a risk factor for adult intestinal toxemia botulism.     

Invasive Group A Streptococcus Outbreaks Associated with Home Healthcare,England, 2018–2019

Healthcare-associated invasive group A Streptococcus (iGAS) outbreaks are common worldwide, but only England has reported outbreaks associated with home healthcare (HHC). We describe 10 outbreaks during 2018–2019 in England. A total of 96 iGAS cases (range 2–39 per outbreak) and 28 deaths (case-fatality rate 29%) occurred. Outbreak duration ranged from 3–517 days; median time between sequential cases was 20.5 days (range 1–225 days). Outbreak identification was difficult, but emm typing and whole-genome sequencing improved detection. Network analyses indicated multiple potential transmission routes. Screening of 366 HHC workers from 9 outbreaks identified group A Streptococcus carriage in just 1 worker. Outbreak control required multiple interventions, including improved infection control, equipment decontamination, and antimicrobial prophylaxis for staff. Transmission routes and effective interventions are not yet clear, and iGAS outbreaks likely are underrecognized. To improve patient safety and reduce deaths, public health agencies should be aware of HHC-associated iGAS.     

Human Group A Streptococci Virulence Genes in Bovine Group C Streptococci

Phage-encoded virulence genes of group A streptococci were detected in 10 (55.6%) of 18 isolates of group C streptococci that had caused bovine mastitis. Bovine isolates carried other genetic determinants, such as composite transposon Tn1207.3/Φ10394.4 (100%) and antimicrobial drug resistance genes erm(B)/erm(A) (22.2%), linB (16.6%), and tet(M)/tet(O) (66.7%), located on mobile elements.