Group C streptococci in human infection: a study of 308 isolates with clinical correlations

A collection of 308 clinical isolates of beta-haemolytic Lancefield group C streptococci was assembled from laboratories in England, Nigeria and New Zealand. Of these, 276 isolates were Streptococcus equisimilis, 23 S. milleri and nine S. zooepidemicus. Isolates of S. equisimilis in the African collection, though few, gave higher rates of lactose and raffinose fermentation, aesculin hydrolysis and positive alpha-galactosidase reactions than those from elsewhere. Erythromycin resistance was found in 1.9% of the English isolates of S. equisimilis. Strains from superficial infections accounted for 88% of the collection and were most commonly isolated from the upper respiratory tract, skin or wounds. Amongst the 36 patients yielding isolates from deep sites S. equisimilis was found in septicaemia, cellulitis, abscess, peritonitis, septic arthritis, pneumonia, mycotic aneurysm and acute epiglottitis, S. milleri was found in abdominal abscesses, peritonitis, pleural empyema and osteomyelitis and S. zooepidemicus was found in septicaemia, pneumonia, meningitis and septic arthritis. Within the collection an unselected general catchment of 214 isolates of group C streptococci from the laboratories in Yorkshire showed the following species: from 199 superficial infections 94% S. equisimilis, 5% S. milleri and 1% S. zooepidemicus and 15 patients with deeper, more aggressive infections 67, 27 and 6.7% of these species respectively.