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Invasive group A streptococcal disease
1University of Washington School of Medicine, Seattle, USA.
Abstract:
The emergence of severe group A streptococcal (GAS) infection since the 1980s has now been reported from most parts of the world. Many of these cases have been associated with deep-seated infection associated with shock and multiple-organ failure and are defined as streptococcal toxic shock syndrome (StrepTSS). Strains of GAS isolated from patients with invasive disease have been predominantly of M types 1 and 3, which produce either pyrogenic exotoxin A or B or both. In this article, the clinical and demographic features of streptococcal bacteremia, myositis, and necrotizing fasciitis are presented and compared with those of StrepTSS. Current concepts about the pathogenesis of invasive streptococcal infection are also discussed, in terms of the interaction between GAS virulence factors and host-defense mechanisms. Finally, the efficacy of clindamycin, the failure of penicillin, and new ideas for future treatment of serious streptococcal infections are outlined.
Insights
Severe group A streptococcal (GAS) infections, including streptococcal toxic shock syndrome (StrepTSS), have increased globally. M types 1 and 3 GAS strains are linked to severe disease, with clindamycin showing efficacy over penicillin.
Area of Science:
- Infectious Diseases
- Microbiology
- Clinical Medicine
Background:
- Since the 1980s, severe group A streptococcal (GAS) infections have emerged worldwide.
- Many cases present as streptococcal toxic shock syndrome (StrepTSS), characterized by deep-seated infection, shock, and multiple-organ failure.
- Predominant GAS strains in invasive disease are M types 1 and 3, producing pyrogenic exotoxins A or B.
Purpose of the Study:
- To present and compare clinical and demographic features of streptococcal bacteremia, myositis, and necrotizing fasciitis with StrepTSS.
- To discuss current concepts on the pathogenesis of invasive streptococcal infections.
- To outline treatment strategies, including antibiotic efficacy and future therapeutic ideas.
Main Methods:
- Review and comparison of clinical and demographic data for various invasive GAS infections.
- Discussion of pathogenesis based on the interaction between GAS virulence factors and host defenses.
- Evaluation of antibiotic efficacy, specifically clindamycin versus penicillin.
Main Results:
- Detailed clinical and demographic profiles of streptococcal bacteremia, myositis, necrotizing fasciitis, and StrepTSS are presented.
- Insights into the mechanisms of invasive GAS infections are provided, focusing on virulence factors and host responses.
- Clindamycin demonstrates efficacy, while penicillin shows failure in treating serious streptococcal infections.
Conclusions:
- Invasive GAS infections, particularly StrepTSS, represent a significant global health challenge.
- Understanding the interplay between GAS virulence and host immunity is crucial for pathogenesis.
- Clindamycin is a recommended treatment for severe GAS infections, necessitating exploration of novel therapeutic approaches.