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Severe group a streptococcal soft-tissue infections in Ontario: 1992-1996
Abdu Sharkawy1, Donald E Low, Raphael Saginur
1Department of Microbiology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada M5G 1X5.
Abstract:
A prospective, population-based, surveillance study of invasive soft-tissue infections due to group A streptococci was conducted in Ontario, Canada, from 1992 through 1996. Demographic and clinical information was obtained by patient interview and chart review. Isolates were characterized by M protein and T agglutination typing. The incidence of necrotizing fasciitis (NF) increased from 0.08 cases per 100,000 population in 1992 to 0.49 cases per 100,000 population in 1995. The case-fatality rate was 13% (68 of 520 patients died). Hypotension and multiorgan dysfunction complicated 64 cases (12%), and NF complicated 119 cases (23%). Underlying diabetes, alcohol abuse, cancer, and cardiac and pulmonary disease increased the risk of disease. Prior use of nonsteroidal anti-inflammatory agents did not influence disease severity. All 197 patients without NF, underlying illness, and hypotension at presentation survived, as did 95 (99%) of 96 normotensive patients who were <65 years old but who had underlying chronic illness. Previously healthy patients without hypotension or NF may be considered for outpatient treatment.
Insights
Invasive group A streptococcal infections rose in Canada, with necrotizing fasciitis (NF) increasing significantly. Early identification and treatment of healthy patients without NF or hypotension can lead to successful outpatient management.
Area of Science:
- Infectious Diseases
- Epidemiology
- Microbiology
Background:
- Group A Streptococcus (GAS) can cause severe invasive soft-tissue infections.
- Necrotizing fasciitis (NF) is a rapidly progressive and life-threatening GAS infection.
- Understanding the epidemiology and risk factors for invasive GAS infections is crucial for public health.
Purpose of the Study:
- To conduct a population-based surveillance study of invasive soft-tissue infections due to group A streptococci in Ontario, Canada.
- To determine the incidence trends of necrotizing fasciitis (NF).
- To identify risk factors and clinical characteristics associated with severe outcomes.
Main Methods:
- Prospective, population-based surveillance study conducted from 1992 to 1996.
- Demographic and clinical data collected via patient interviews and chart reviews.
- Bacterial isolates characterized by M protein and T agglutination typing.
Main Results:
- The incidence of necrotizing fasciitis (NF) increased from 0.08 to 0.49 cases per 100,000 population between 1992 and 1995.
- The overall case-fatality rate was 13% (68 of 520 patients).
- Hypotension and multiorgan dysfunction occurred in 12% of cases; NF complicated 23% of cases. Underlying conditions like diabetes, alcohol abuse, cancer, and cardiac/pulmonary disease increased risk.
Conclusions:
- Invasive group A streptococcal infections, particularly NF, showed an increasing incidence during the study period.
- Patients without NF, underlying illness, and hypotension at presentation had a favorable prognosis and may be candidates for outpatient treatment.
- Early recognition and appropriate management are critical for improving outcomes in severe streptococcal soft-tissue infections.