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[Invasive infections due to group A beta-haemolytic streptococci in two families]
M J Coenraad1, E A Thewessen, F P Bakker
1Afd. Interne Geneeskunde, Groene Hart Ziekenhuis, Gouda. m.j.coenraad@lumc.nl
Abstract:
An invasive beta-haemolytic Lancefield group A streptococcal (GAS) infection was diagnosed in 4 patients: a 70-year-old woman, her 71-year-old husband, a 62-year-old woman and her 43-year-old son. In the married couple the infection was caused by GAS-type TB3264M100. The woman had a pneumonia, whilst her husband developed a streptococcal toxic shock-like syndrome; he died. The other woman and her son were infected with GAS-type T6M6. The son died of a circulatory arrest due to necrotizing fascitis from a wound in his arm. His mother recovered following a severe tonsillitis. The number of invasive GAS infections has increased in the past decades. GAS infections occur mostly in isolated cases, but clusters of patients are also seen, like the two described here. The risk of an invasive GAS-infection is greatest if one has been in the neighbourhood of the index patient during the week prior to the diagnosis in that patient. According to the latest (American) guidelines, there is no reason for prophylactic treatment of the close contacts of patients.
Insights
Clusters of invasive Group A Streptococcus (GAS) infections highlight transmission risks. While some patients died from severe conditions like toxic shock syndrome and necrotizing fasciitis, close contact monitoring is advised, though prophylactic treatment for contacts isn't recommended.
Area of Science:
- Infectious Diseases
- Microbiology
- Public Health
Background:
- Invasive Group A Streptococcus (GAS) infections are a growing public health concern.
- GAS infections can manifest in various severe forms, including pneumonia, streptococcal toxic shock-like syndrome, and necrotizing fasciitis.
- Recent decades have seen an increase in invasive GAS cases.
Observation:
- Four patients presented with invasive GAS infections, including two distinct clusters.
- A married couple was infected with GAS-type TB3264M100; the wife had pneumonia, and the husband died from streptococcal toxic shock-like syndrome.
- Another pair, a mother and son, were infected with GAS-type T6M6; the son died from necrotizing fasciitis, while the mother recovered from severe tonsillitis.
Findings:
- Specific GAS strains (TB3264M100 and T6M6) were identified in the observed clusters.
- The study identified a heightened risk of invasive GAS infection for individuals in close proximity to an index patient.
- Mortality occurred in two cases, emphasizing the potential severity of invasive GAS.
Implications:
- The findings underscore the importance of recognizing and managing clusters of invasive GAS infections.
- Understanding transmission dynamics, particularly proximity to index patients, is crucial for risk assessment.
- Current guidelines suggest no prophylactic treatment for close contacts, but vigilance remains essential.