Fulminant invasive group A streptococcal infection in children
- Authors: Yatsyshina S.B.1, Mamoshina M.V.1, Elkina M.A.1, Polyaeva O.A.1, Mikhailova Y.V.1, Shelenkov A.A.1, Egorova A.E.1, Maleev V.V.1
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Affiliations:
- Central Research Institute of Epidemiology of the Federal Service for Supervision of Consumer Rights Protection and Human Well-being
- Issue: Vol 13, No 6 (2023)
- Pages: 1009-1017
- Section: REVIEWS
- URL: https://journals.rcsi.science/2220-7619/article/view/252301
- DOI: https://doi.org/10.15789/2220-7619-FIG-15637
- ID: 252301
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Abstract
Group A streptococcal infections dominate among invasive streptococcal infections, with the major causative agent, Streptococcus pyogenes, being quite stable in the environment and bearing a large number of chromosome encoded pathogenicity factors or transmitted by horizontal transfer through bacteriophages. Different genetic variants of S. pyogenes can have a different set of pathogenicity factors able to change during pathogen evolution and determine virulence level for specific isolate. With a short incubation period, the disease can proceed with developing invasive infection and toxic shock syndrome with unfavorable outcome within 7 days from disease onset. The purpose of this article is to increase the doctors’ alertness to early recognition and diagnosis, which directly affects adequate treatment in a timely manner and disease outcome. The data on streptococcal morbidity in Russia and worldwide, review of laboratory diagnostic methods and pathogen genetic typing are presented. The maximum number of cases of streptococcal septicemia in Russia was registered in 2022, which accounted for 69% of all cases during the 2014–2022 observation period. The article also describes two clinical cases of fulminant invasive group A streptococcal infection in children with symptoms of acute respiratory viral infections at the onset of the disease. The results of various laboratory diagnostics methods verifying the diagnosis are presented. The genetic characterization of microbial isolates was performed by deep DNA sequencing. In the biological material from patients (including autopsy in one case), S. pyogenes sequence type ST-28, serotypes emm-1.25 and emm-1.0 were identified. The increasing importance of invasive streptococcal infection for health care in Russia and other countries may be associated with a possible change in dominating S. pyogenes genetic variants. In this regard, the study on circulating S. pyogenes genotypes on an ongoing basis as part of surveillance of streptococcal infection and development of vaccine for specific prevention are required.
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##article.viewOnOriginalSite##About the authors
S. B. Yatsyshina
Central Research Institute of Epidemiology of the Federal Service for Supervision of Consumer Rights Protection and Human Well-being
Email: svetlana.yatsyshina@pcr.ms
PhD (Biology), Head of Laboratory of Molecular Diagnostics and Epidemiology of Respiratory Infections, Department of Molecular Diagnostics and Epidemiology
Russian Federation, MoscowM. V. Mamoshina
Central Research Institute of Epidemiology of the Federal Service for Supervision of Consumer Rights Protection and Human Well-being
Email: svetlana.yatsyshina@pcr.ms
Junior Researcher, Laboratory of Molecular Diagnostics and Epidemiology of Respiratory Infections, Department of Molecular Diagnostics and Epidemiology
Russian Federation, MoscowM. A. Elkina
Central Research Institute of Epidemiology of the Federal Service for Supervision of Consumer Rights Protection and Human Well-being
Email: svetlana.yatsyshina@pcr.ms
Junior Researcher, Laboratory of Molecular Diagnostics and Epidemiology of Respiratory Infections, Department of Molecular Diagnostics and Epidemiology
Russian Federation, MoscowO. A. Polyaeva
Central Research Institute of Epidemiology of the Federal Service for Supervision of Consumer Rights Protection and Human Well-being
Email: svetlana.yatsyshina@pcr.ms
Epidemiologist, Laboratory of Molecular Diagnostics and Epidemiology of Respiratory Infections, Department of Molecular Diagnostics and Epidemiology
Russian Federation, MoscowYu. V. Mikhailova
Central Research Institute of Epidemiology of the Federal Service for Supervision of Consumer Rights Protection and Human Well-being
Email: svetlana.yatsyshina@pcr.ms
PhD (Biology), Head of Laboratory of Molecular Mechanisms of Antibiotic Resistance, Department of Molecular Diagnostics and Epidemiology
Russian Federation, MoscowA. A. Shelenkov
Central Research Institute of Epidemiology of the Federal Service for Supervision of Consumer Rights Protection and Human Well-being
Email: svetlana.yatsyshina@pcr.ms
PhD (Physics and Mathematics), Senior Researcher, Laboratory of Molecular Mechanisms of Antibiotic Resistance
Russian Federation, MoscowA. E. Egorova
Central Research Institute of Epidemiology of the Federal Service for Supervision of Consumer Rights Protection and Human Well-being
Author for correspondence.
Email: svetlana.yatsyshina@pcr.ms
Researcher, Laboratory of Molecular Mechanisms of Antibiotic Resistance, Department of Molecular Diagnostics and Epidemiology
Russian Federation, MoscowV. V. Maleev
Central Research Institute of Epidemiology of the Federal Service for Supervision of Consumer Rights Protection and Human Well-being
Email: svetlana.yatsyshina@pcr.ms
RAS Full Member, DSc (Medicine), Professor, Advisor to the Director for Scientific Work
Russian Federation, MoscowReferences
- Брико Н.И., Глушкова Е.В., Носик А.Г., Дмитриев А.В., Дмитриева Н.Ф., Клейменов Д.А., Липатов К.В. Частота заболеваний, вызываемых стрептококками группы А, среди инвазивных инфекций мягких тканей, и характеристика возбудителя // Журнал микробиологии, эпидемиологии и иммунобиологии. 2014. Т. 91, № 5. C. 24–31. [Briko N.I., Glushkova E.V., Nosik A.G., Dmitriev A.V., Dmitrieva N.F., Kleimenov D.A., Lipatov K.V. Frequency of diseases caused by group A streptococci among invasive infections of soft tissues and characteristics of the causative agent. Zhurnal mikrobiologii, epidemiologii i immunobiologii = Journal of Microbiology, Epidemiology and Immunobiology, 2014, vol. 91, no. 5, pp. 24–31. (In Russ.)]
- Брико Н.И., Глушкова Е.В. Состояние и тенденции эпидемической ситуации по стрептококковой (группы А) инфекции в России в последние годы // Журнал микробиологии, эпидемиологии и иммунобиологии. 2018. Т. 95, № 1. C. 10–16. [Briko N.I., Glushkova E.V. Status and trends of the epidemic situation of group A streptococcal (GAS) infections in Russia in recent years. Zhurnal mikrobiologii, epidemiologii i immunobiologii = Journal of Microbiology, Epidemiology and Immunobiology, 2018, vol. 95, no. 1, pp. 10–16. (In Russ.)] doi: 10.36233/0372-9311-2018-1-10-16
- Профилактика стрептококковой (группы А) инфекции. Федеральные клинические рекомендации. М., 2013. 43 с. [Prevention of streptococcal (group A) infections. Federal clinical guidelines. Moscow, 2013. 43 p. (In Russ.)] URL: https://antimicrob.net/wp-content/uploads/Profilaktika-streptokokkovoi%CC%86_gruppy-A_-infekcii.pdf (23.08.2023)
- Эпидемиологический надзор и профилактика стрептококковой (группы А) инфекции: методические указания. М.: Федеральный центр госсанэпиднадзора Минздрава России, 2005. 52 с. [Epidemiological surveillance and prevention of group A streptococcal infection: Guidelines. Moscow: Federal Center for State Sanitary and Epidemiological Surveillance of the Ministry of Health of Russia, 2005 (In Russ.)] URL: https://www.rospotrebnadzor.ru/documents/details.php?ELEMENT_ID=4737&ysclid=llnv16nvs9633412789 (23.08.2023)
- Бурова Л.А., Тотолян Артем А. Основные факторы патогенности Streptococcus pyogenes // Инфекция и иммунитет. 2022. Т. 12, № 1. C. 33–50. [Burova L.A., Totolian A.A. Major pathogenicity factors of Streptococcus pyogenes. Infektsiya i immunitet = Russian Journal of Infection and Immunity, 2022, vol. 12, no. 1, pp. 33–50. (In Russ.)] doi: 10.15789/2220-7619-MPF-1723
- Острый тонзиллит и фарингит (Острый тонзиллофарингит). Клинические рекомендации. М., 2021. 51 с. [Acute tonsillitis and pharyngitis (Acute tonsillopharyngitis). Clinical guidelines. Moscow, 2021. 51 p. (In Russ.)] URL: https://cr.minzdrav.gov.ru/recomend/306_2?ysclid=llnvopk3x4938558389 (23.08.2023)
- Захарова И.Н., Бережная И.В., Майкова И.Д., Дубовец Н.Ф., Дмитриева Д.К. Острый тонзиллофарингит стрептококковой этиологии у детей: важность быстрой диагностики // Российский медицинский журнал. 2023. № 2. С. 67–71. [Zakharova I.N., Berezhnaya I.V., Maykova I.D., Dubovets N.F., Dmitrieva D.K. Acute tonsillopharyngitis of streptococcal etiology in children: the importance of rapid diagnosis. Rossiyskiy meditsinskiy zhurnal = Russian Medical Journal, 2023, no. 2, pp. 67–71. (In Russ.)]
- Brouwer S., Rivera-Hernandez T., Curren B.F., Harbison-Price N., De Oliveira D.M.P., Jespersen M.G., Davies M.R., Walker M.J. Pathogenesis, epidemiology and control of Group A streptococcus infection. Nat. Rev. Microbiol., 2023, vol. 21, no. 7, pp. 431–447. doi: 10.1038/s41579-023-00865-7
- Chiang-Ni C., Zheng P.X., Ho Y.R., Wu H.M., Chuang W.J., Lin Y.S., Lin M.T., Liu C.C., Wu J.J. emm1/sequence type 28 strains of group A streptococci that express covR at early stationary phase are associated with increased growth and earlier SpeB secretion. J. Clin. Microbiol., 2009, vol. 47, no. 10, pp. 3161–3169. doi: 10.1128/JCM.00202-09
- Dale J.B., Walker M.J. Update on group A streptococcal vaccine development. Curr. Opin. Infect. Dis., 2020, vol. 33, no. 3, pp. 244–250. doi: 10.1097/QCO.0000000000000644
- Enright M.C., Spratt B.G., Kalia A., Cross J.H., Bessen D.E. Multilocus sequence typing of Streptococcus pyogenes and the relationships between emm type and clone. Infect. Immun., 2001, vol. 69, no. 4, pp. 2416–2427. doi: 10.1128/IAI.69.4.2416-2427.2001
- Grivea I.N., Syrogiannopoulos G.A., Michoula A.N., Gazeti G., Malli E., Tsilipounidaki K., Fouzas S., Anthracopoulos M.B., Petinaki E. emm Types and clusters and macrolide resistance of pediatric group A streptococcal isolates in Central Greece during 2011–2017. PLoS One, 2020, vol.15, no. 5: e0232777. doi: 10.1371/journal.pone.0232777
- Johannesen T.B., Munkstrup C., Edslev S.M., Baig S., Nielsen S., Funk T., Kristensen D.K., Jacobsen L.H., Ravn S.F., Bindslev N., Gubbels S., Voldstedlund M., Jokelainen P., Hallstrøm S., Rasmussen A., Kristinsson K.G., Fuglsang-Damgaard D., Dessau R.B., Olsén A.B., Jensen C.S., Skovby A., Ellermann-Eriksen S., Jensen T.G., Dzajic E., Østergaard C., Lomborg Andersen S., Hoffmann S., Andersen P.H., Stegger M. Increase in invasive group A streptococcal infections and emergence of novel, rapidly expanding sub-lineage of the virulent Streptococcus pyogenes M1 clone, Denmark, 2023. Euro Surveill., 2023, vol. 28, no. 26: 2300291. doi: 10.2807/1560-7917.ES.2023.28.26.2300291
- McGregor K.F., Spratt B.G., Kalia A., Bennett A., Bilek N., Beall B., Bessen D.E. Multilocus sequence typing of Streptococcus pyogenes representing most known emm types and distinctions among subpopulation genetic structures. J. Bacteriol., 2004, vol. 186, no. 13, pp. 4285–4294. doi: 10.1128/JB.186.13.4285-4294.2004
- McMillan D.J., Drèze P.A., Vu T., Bessen D.E., Guglielmini J., Steer A.C., Carapetis J.R., Van Melderen L., Sriprakash K.S., Smeesters P.R. Updated model of group A streptococcus M protein based on a comprehensive worldwide study. Clin. Microbiol. Infect., 2013, vol. 19, no. 5, pp. E222–E229. doi: 10.1111/1469-0691.12134
- Reglinski M., Sriskandan S. Chapter 38 — Streptococcus pyogenes. In: Molecular Medical Microbiology (Second Edition). Academic Press, 2015, pp. 675–716. doi: 10.1016/B978-0-12-397169-2.00038-X
- Streptococcus Laboratory: Blast-emm & emm databases. URL: https://www2.cdc.gov/vaccines/biotech/strepblast.asp (23.08.2023)
- Streptococcus Laboratory: M Protein Gene (emm) Typing |. URL: https://www.cdc.gov/streplab/groupa-strep/emm-background.html (23.08.2023)
- Van der Putten B.C.L., Bril-Keijzers W.C.M., Rumke L.W., Vestjens S.M.T., Koster L.A.M., Willemsen M., van Houten M.A., Rots N.Y., Vlaminckx B.J.M., de Gier B., van Sorge N.M. Novel emm4 lineage associated with an upsurge in invasive group A streptococcal disease in the Netherlands, 2022. Microb. Genom., 2023. vol. 9, no. 6: mgen001026. doi: 10.1099/mgen.0.001026
- WHO. Increase in invasive Group A streptococcal infections among children in Europe, including fatalities. URL: https://www.who.int/europe/ru/news/item/12-12-2022-increase-in-invasive-group-a-streptococcal-infections-among-children-in-europe--including-fatalities (06.06.2023)
- WHO. Increased incidence of scarlet fever and invasive group A streptococcus infection — multi-country. URL: https://www.who.int/ru/emergencies/disease-outbreak-news/item/2022-DON429 (06.06.2023)
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