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Molecular Characterization of Streptococcus pyogenes Causing Invasive Disease in Pediatric Population in Spain A
Viviana Sánchez-Encinales1, Guillermo Ludwig2, Esther Tamayo3
1From the Microbiology Department, Donostia University Hospital-Biodonostia Health Research Institute, Donostia-San Sebastian.
Insights
Invasive Streptococcus pyogenes infections in Spanish children showed stable incidence over 12 years, with pneumonia and sepsis being common. The emm1 clone predominated, and a 30-valent vaccine could cover most cases.
Area of Science:
- Microbiology
- Epidemiology
- Pediatrics
Background:
- Streptococcus pyogenes (group A Streptococcus) is a significant bacterial pathogen causing a range of infections.
- Invasive Streptococcus pyogenes disease (iGAS) in children is a serious concern with potential for severe outcomes.
- Understanding the epidemiology of iGAS is crucial for public health surveillance and intervention strategies.
Purpose of the Study:
- To describe the epidemiology of invasive Streptococcus pyogenes disease in pediatric populations in Catalonia and Gipuzkoa, Spain, over a 12-year period (2005-2016).
- To characterize the molecular features, including emm-types and exotoxin gene profiles, of circulating Streptococcus pyogenes strains.
- To assess the incidence, clinical presentations, and mortality rates associated with pediatric iGAS.
Main Methods:
- Retrospective analysis of all Streptococcus pyogenes isolates from invasive infections in pediatric patients from 2005 to 2016.
- Determination of emm-type and the presence of 13 exotoxin genes in 93 isolates.
- Multi Locus Sequence Typing (MLST) performed on 10% of isolates representing different emm-types.
Main Results:
- 103 cases of iGAS were detected, with incidence rates of 2.5-2.6 per 100,000 children in Gipuzkoa and Catalonia, respectively, showing no significant temporal trends.
- Pneumonia (26.2%), bacteremia/sepsis (23.3%), and septic arthritis/osteomyelitis (22.3%) were the most frequent clinical presentations.
- The emm1/ST28 clone was the most prevalent (40.9%), and a 30-valent vaccine formulation could cover 96.8% of the identified isolates.
Conclusions:
- Invasive Streptococcus pyogenes disease in children in Spain exhibited a stable incidence over the study period.
- The emm1 clone is the dominant cause of iGAS in this pediatric population.
- Molecular characterization, including emm-typing and exotoxin gene profiling, is essential for understanding pathogen dynamics and informing vaccine development.
Objectives:
To perform a comprehensive description of the epidemiology of Streptococcus pyogenes invasive disease in the pediatric population in 2 regions of Spain (Catalonia and Gipuzkoa) through 12 years.
Methods:
All S. pyogenes isolates causing invasive disease in pediatric patients between 2005 and 2016 were included. The emm-type and the presence of 13 exotoxin genes (speA, speB, speC, speF, speG, speH, speI, speJ, speK, speL, speM, smeZ, ssa and slo) were determined in all 93 available isolates and the Multi Locus Sequece Typing in 10% of isolates of each different emm-type.
Results:
Overall, 103 cases of S. pyogenes invasive infections were detected: 77 in Catalonia and 26 in Gipuzkoa, being 50.5% females. The incidence rate per 100,000 children was 2.5 for Gipuzkoa and 2.6 for Catalonia, with no significant temporal trends. The median age was 30 months. The most frequent clinical presentations were: pneumonia (26.2%), bacteremia/sepsis (23.3%), septic arthritis/osteomyelitis (22.3%), cellulitis/mastoiditis (12.6%) and meningitis (6.8%). Eight children developed streptococcal toxic shock syndrome. Nine cases were preceded by varicella infection. The associated mortality rate was 3.9%. Three isolates were resistant to erythromycin, being one of them also resistant to clindamycin and 4 isolates were resistant to levofloxacine. Forteen different emm-types were detected being emm1/ST28 (40.9%) the most frequent clone in both regions followed by emm12/ST36-ST242, emm6/ST382, emm3/ST15, emm75/ST150 and emm4/ST38-39. speA gene was only detected in emm1 and emm3 isolates. Eight exotoxins were enough to assign an emm-type with a very high degree of accuracy (95%). The 30-valent vaccine would include 96.8% of isolates.
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