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[Invasive group A streptococcal infections in France]
Objectives:
Following the recent report of necrosing fasciitis cases in Great Britain, we conducted a study of group A streptococci infections in France to evaluate the frequency and severity of the different clinical presentations, particularly necrosing fasciitis.
Methods:
Thirteen hospital laboratories were selected because of the large number of group A streptococci blood cultures they observed in 1993. The microbiologists in these hospitals, in relation with clinicians, identified 83 patients with a group A streptococci bacteraemia between January 1, 1993 and June 30, 1994.
Results:
Sixty-three percent of the patients had an underlying condition: 39% had a chronic general or local disease and 24% had severe immunodepression. The skin portal of entry was found for 70% of the cases. Patients were divided into 4 groups according to the clinical picture: there were 16 cases of streptococci shock syndrome, 13 with deep infections, 25 infections of soft tissue (including 3 cases of fasciitis) and 29 cases of isolated bacteraemia.
Conclusion:
Overall, one-fourth of the patients died due to the streptococci infection, one-half of whom had a toxic shock syndrome. Mortality was correlated with age and health status, but also with the clinical presentation of the disease. Compared with former years, there was no increase in the number of group A streptococci infections, nor in the number of necrotizing fasciitis in France in 1993. However, streptococci shock syndrome is of particular importance because of its frequency and poor outcome.
Insights
Group A streptococci infections in France showed no increase in 2023, but streptococci shock syndrome is a significant concern due to its high mortality rate.
Area of Science:
- Infectious Diseases
- Microbiology
- Epidemiology
Context:
- Recent reports of necrotizing fasciitis in Great Britain prompted an investigation into Group A Streptococcus (GAS) infections in France.
- The study aimed to assess the prevalence and clinical spectrum of GAS infections, focusing on necrotizing fasciitis.
Purpose:
- To evaluate the frequency and severity of various clinical presentations of Group A Streptococcus infections in France.
- To specifically assess the occurrence of necrotizing fasciitis within the broader context of GAS bacteremia.
Summary:
- A study of 83 patients with Group A Streptococcus bacteremia in France (1993-1994) revealed underlying conditions in 63% and skin entry in 70%.
- Clinical presentations included streptococci shock syndrome (16 cases), deep infections (13), soft tissue infections (25, including 3 fasciitis), and isolated bacteremia (29).
- Mortality was 25%, with half of deaths in toxic shock syndrome patients. No increase in GAS or necrotizing fasciitis was observed compared to previous years.
Impact:
- Identifies streptococci shock syndrome as a critical, high-mortality GAS presentation requiring attention.
- Correlates mortality with patient age, health status, and clinical manifestation.
- Provides baseline data on GAS infections in France, useful for future epidemiological surveillance.