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Streptococcus pyogenes Pneumonia in Adults: Clinical Presentation and Molecular Characterization of Isolates

Esther Tamayo¹, Milagrosa Montes^1,2, Diego Vicente^1,2

¹Biomedical Research Center Network for Respiratory Diseases (CIBERES), San Sebastián, Spain.

|March 31, 2016

Abstract

Introduction:

In the preantibiotic era Streptococcus pyogenes was a common cause of severe pneumonia but currently, except for postinfluenza complications, it is not considered a common cause of community-acquired pneumonia in adults.

Aim And Material And Methods:

This study aimed to identify current clinical episodes of S. pyogenes pneumonia, its relationship with influenza virus circulation and the genotypes of the involved isolates during a decade in a Southern European region (Gipuzkoa, northern Spain). Molecular analysis of isolates included emm, multilocus-sequence typing, and superantigen profile determination.

Results:

Forty episodes were detected (annual incidence 1.1 x 100,000 inhabitants, range 0.29-2.29). Thirty-seven episodes were community-acquired, 21 involved an invasive infection and 10 developed STSS. The associated mortality rate was 20%, with half of the patients dying within 24 hours after admission. Influenza coinfection was confirmed in four patients and suspected in another. The 52.5% of episodes occurred outside the influenza seasonal epidemic. The 67.5% of affected persons were elderly individuals and adults with severe comorbidities, although 13 patients had no comorbidities, 2 of them had a fatal outcome. Eleven clones were identified, the most prevalent being emm1/ST28 (43.6%) causing the most severe cases.

Conclusions:

S. pyogenes pneumonia had a continuous presence frequently unrelated to influenza infection, being rapidly fatal even in previously healthy individuals.

Insights

Streptococcus pyogenes pneumonia remains a serious threat, often occurring independently of influenza. This bacterial pneumonia can be rapidly fatal, even in healthy individuals, highlighting its persistent danger.

Area of Science:

Infectious Diseases
Bacteriology
Epidemiology

Background:

Streptococcus pyogenes was historically a major cause of pneumonia before antibiotics.
Currently, it's not widely recognized as a common cause of adult community-acquired pneumonia, except in post-influenza cases.

Purpose of the Study:

To investigate contemporary Streptococcus pyogenes pneumonia cases.
To determine the link between S. pyogenes pneumonia and influenza virus circulation.
To analyze the genetic profiles of S. pyogenes isolates over a decade in Northern Spain.

Main Methods:

Molecular analysis of S. pyogenes isolates.
Included emm typing, multilocus-sequence typing (MLST), and superantigen profiling.
Retrospective decade-long study in Gipuzkoa, Spain.

Main Results:

Forty episodes of S. pyogenes pneumonia were identified (incidence 1.1/100,000 annually).
Most cases were community-acquired (37/40), with 21 invasive infections and 10 developing streptococcal toxic shock syndrome (STSS).
Mortality was high (20%), with a significant proportion of cases occurring outside influenza season and affecting elderly/comorbid individuals, but also previously healthy ones.

Conclusions:

S. pyogenes pneumonia persists as a significant clinical threat.
The infection is often unrelated to concurrent influenza activity.
The condition can be rapidly fatal, irrespective of patient comorbidities.

Read full analysis

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