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Simultaneous Streptococcus and picornavirus infection. Muscle involvement in acute rhabdomyolysis
Abstract:
Streptococci seldom invade muscle in healthy people with intact integument. However, infection with another agent simultaneously may change this general observation. In a two-week period we encountered dual infections with group A, beta-hemolytic streptococci and a picornavirus in each of two hospitalized patients. Both were acutely ill; one died. Renal failure developed in the patient who survived and rhabdomyolysis was demonstrated in the patient who died. Picornavirus titer increases were demonstrated in the patient who survived, and viral inclusions in muscle cells were demonstrated by light microscopy in necropsy specimens and confirmed by electron microscopy in the second patient. We believe that streptococcal invasion of muscle may be facilitated during an outbreak of certain picornavirus infections.
Insights
Group A streptococci rarely infect muscle, but dual infections with picornaviruses can occur. This study observed severe outcomes, including death and rhabdomyolysis, suggesting picornaviruses may facilitate streptococcal muscle invasion.
Area of Science:
- Infectious Diseases
- Virology
- Microbiology
Background:
- Group A beta-hemolytic streptococci (GABS) typically do not invade muscle tissue in healthy individuals with intact skin.
- Concurrent infections can alter the typical presentation and outcomes of common pathogens.
Observation:
- Two hospitalized patients presented with simultaneous GABS and picornavirus infections over a two-week period.
- Both patients experienced severe illness, with one succumbing to the infection.
Findings:
- The surviving patient developed renal failure, while the deceased patient exhibited rhabdomyolysis.
- Picornavirus titers increased in the survivor, and viral inclusions were identified in muscle cells of the deceased patient via microscopy.
- Electron microscopy confirmed viral inclusions in muscle tissue.
Implications:
- These findings suggest a potential synergistic relationship between picornavirus infections and GABS.
- Picornavirus outbreaks may increase the risk of invasive streptococcal myositis (muscle infection).
- Further research is warranted to elucidate the mechanisms facilitating streptococcal muscle invasion during picornavirus infections.