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Clinical and molecular characteristics of infective β-hemolytic streptococcal endocarditis
Oddvar Oppegaard1, Haima Mylvaganam2, Steinar Skrede1
1Department of Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway.
Abstract:
Streptococcus pyogenes (S. pyogenes) and Streptococcus dysgalactiae subspecies equisimilis (SDSE) cause considerable morbidity and mortality, and show similarities in disease manifestations and pathogenic mechanisms. Their involvement in infective endocarditis, however, has not been well described. Invasive S. pyogenes and SDSE infections in Health Region Bergen, Norway, in the period 1999-2013 were reviewed, and sixteen cases of endocarditis were identified. The median duration of symptoms was 2.5days, the frequency of embolic events 50%, 38% received valve replacement and the 30-day mortality was 25%. In S. pyogenes, a significant correlation was observed between the repertoire of fibronectin-binding genes, phenotypic binding ability to fibronectin and disease manifestations. Conversely, no associations between phenotypic and genotypic characteristics were detected in SDSE. S. pyogenes and SDSE endocarditis is characterized by rapid and severe clinical manifestations. The pathogenesis is multifactorial, but our results infer a potential role of fibronectin binding in the development of S. pyogenes endocarditis.
Insights
Streptococcus pyogenes and Streptococcus dysgalactiae subspecies equisimilis cause severe endocarditis. Fibronectin binding may play a role in Streptococcus pyogenes endocarditis development, but not in SDSE.
Area of Science:
- Infectious Diseases
- Cardiology
- Microbiology
Background:
- Streptococcus pyogenes (S. pyogenes) and Streptococcus dysgalactiae subspecies equisimilis (SDSE) are significant pathogens.
- Their roles in infective endocarditis are not well-established.
- Both species share disease manifestations and pathogenic mechanisms.
Purpose of the Study:
- To investigate the clinical characteristics and outcomes of S. pyogenes and SDSE endocarditis.
- To explore potential associations between bacterial genotypic/phenotypic traits and disease presentation.
Main Methods:
- Retrospective review of invasive S. pyogenes and SDSE infections.
- Identification and analysis of 16 endocarditis cases from 1999-2013.
- Correlation of fibronectin-binding genes with phenotypic binding and clinical data.
Main Results:
- Endocarditis cases presented with a median symptom duration of 2.5 days.
- Embolic events occurred in 50% of patients, 38% required valve replacement, and 30-day mortality was 25%.
- A correlation between fibronectin-binding genes, phenotype, and disease was found in S. pyogenes, but not SDSE.
Conclusions:
- S. pyogenes and SDSE endocarditis are severe, rapidly progressing infections.
- Fibronectin binding may be a factor in S. pyogenes endocarditis pathogenesis.
- Further research is needed to elucidate the multifactorial pathogenesis of these infections.
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