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Streptococcus pyogenes bacteraemia in Cambridge--a review of 67 episodes
1Clinical Microbiology Laboratory, Addenbrooke's Hospital, Cambridge.
Abstract:
Sixty-seven episodes of bacteraemia due to Lancefield Group A streptococci occurred in patients admitted to or autopsied at Addenbrooke's Hospital, Cambridge from July 1974 to June 1986. Ninety-two per cent of infections were acquired in the community and 71 per cent of patients were adults. The overall mortality rate was 48 per cent and 15 per cent of cases died at home shortly after the onset of illness. Thirty-eight per cent of the patients had underlying disease and sixty-one per cent of these died compared with 40 per cent of those without underlying disease. Presentation in shock was the major predictor of mortality (79 versus 16 per cent) and was commoner in adults. Clinical features were variable and led to incorrect initial diagnosis in some cases. A localized site of infection was not recognized initially in 37 per cent of cases but the commonest evident site of entry was the skin. Annual incidence varied with age from 0.71 to 4.16/100,000 population and cases were commonest in the young and those over 50. The fulminating onset of community-acquired streptococcal infection in some adults emphasizes the importance of early treatment of suspected cases with penicillins.
Insights
Group A streptococcal bacteraemia, primarily community-acquired, had a high mortality rate (48%). Shock presentation was a key predictor of death, underscoring the need for prompt penicillin treatment in suspected cases.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Epidemiology
Background:
- Lancefield Group A streptococci can cause severe invasive infections.
- Bacteraemia, particularly community-acquired, poses a significant public health challenge.
- Understanding risk factors and clinical presentations is crucial for effective management.
Purpose of the Study:
- To analyze episodes of Group A streptococcal bacteraemia.
- To identify epidemiological characteristics, clinical features, and mortality predictors.
- To inform early diagnosis and treatment strategies.
Main Methods:
- Retrospective analysis of 67 bacteraemia episodes.
- Data collection from patient admissions and autopsies at Addenbrooke's Hospital (1974-1986).
- Evaluation of patient demographics, underlying conditions, clinical presentation, and outcomes.
Main Results:
- Most infections (92%) were community-acquired, predominantly in adults (71%).
- Overall mortality was high (48%), with shock being a major predictor (79% mortality).
- Underlying disease increased mortality risk; skin was the commonest entry site.
Conclusions:
- Group A streptococcal bacteraemia has a substantial mortality rate, especially in adults presenting with shock.
- Early recognition and penicillin treatment are vital for improving outcomes.
- Incidence varies by age, with higher rates in the very young and elderly.