Search

We report a group A streptococcal outbreak in a geriatric mental health inpatient unit. Communication with cognitively impaired patients, limitations in adherence to hygiene practices, and communal dining may have facilitated transmission. Settle plates aided in identifying a colonized patient. Rapid access to whole-genome sequencing facilitated assessment and management. • GAS outbreaks may occur in any congregate setting housing frail older adults. • Whole genome sequencing could facilitate assessment and management. • Settles plates may help identify colonized patients when routine swabs cannot be obtained. [ABSTRACT FROM AUTHOR]

• Pediatric GAS pharyngitis cases are higher than prepandemic levels. • Concurrent URIs and GAS pharyngitis presentations are increasing. • Limited guidelines exist to differentiate overlapping URI and GAS presentations. • Deciding to test for GAS is hard, considering the overlapping features with URI. • Accurate GAS diagnosis is critical to optimize antibiotic stewardship. Group A Streptococcus (GAS) pharyngitis has increased in case presentations, higher than prepandemic data. GAS pharyngitis requires appropriate antibiotic treatment to reduce the risk of subsequent complications if not recognized and treated promptly. However, regional observations have noted an increase in overlapping symptoms of GAS pharyngitis and viral upper respiratory infection symptoms, making the decisions to test for GAS more complex. Current guidelines do not delineate testing and treatment guidelines for this presentation scenario. This case report describes a 5-year-old female with overlapping GAS and upper respiratory infection symptoms, who tested positive via rapid GAS pharyngeal test and was treated with oral antibiotics. [ABSTRACT FROM AUTHOR]

A 42-year-old man with a history of acute myocarditis after streptococcal pharyngitis developed recurrent fulminant myocarditis. Endomyocardial biopsy revealed myocyte degeneration, interstitial edema, and neutrophil infiltration. The patient's cardiac function deteriorated rapidly, and he died despite mechanical circulatory support. Autopsy revealed neutrophil infiltration, interstitial edema, and micro-abscesses containing masses of streptococci and neutrophilic phagocytosis within the myocardium. The patient did not meet the diagnostic criteria for acute rheumatic fever; thus, he was diagnosed with non-rheumatic streptococcal myocarditis. Non-rheumatic streptococcal myocarditis rarely recurs, but it can be fulminant upon recurrence. We report a rare case of recurrent fulminant non-rheumatic streptococcal myocarditis. Endomyocardial biopsy and autopsy revealed neutrophil infiltration and micro-abscesses containing bacterial masses of streptococci and neutrophilic phagocytosis in the myocardium. The patient did not meet the diagnostic criteria for acute rheumatic fever; thus, he was diagnosed with non-rheumatic streptococcal myocarditis. Non-rheumatic streptococcal myocarditis rarely recurs, but it can be fulminant upon recurrence. [ABSTRACT FROM AUTHOR]

Throat infections, referred to as pharyngitis, are most commonly of viral origin; however, bacterial pharyngitis does occur, in which case group A streptococci (GAS) is the most observed causative pathogen. Regardless of the aetiology, pharyngitis is typically a self-limiting condition. Viral cases are managed by providing symptomatic treatment of inflammation and pain. GAS is managed with antimicrobials, after a Centor Criteria score has been calculated and a throat swab or rapid antigen test performed, should it be indicated. The biggest concern with GAS is the associated complications, such as acute rheumatic fever, which enforces the importance of an accurate diagnosis. [ABSTRACT FROM AUTHOR]

Objectives: Rates of acute rheumatic fever, a sequelae of group A Streptococcal (GAS) infection, remain unacceptably high in Indigenous Māori and Pacific children in New Zealand. This prospective study aimed to describe GAS antibody titres in healthy children (5-14 years) by ethnicity, and to determine how paired titres vary with GAS culture positive and negative pharyngitis, and GAS skin infections.Methods: Analysis included 887 children (32% Māori, 36% Pacific, 33% European/Other) from Auckland, New Zealand. Cases comprise 772 children who had a sore throat or skin infection, which resulted in a swab taken for culture. Healthy controls were asymptomatic (N = 154) and matched by age, ethnicity and region. All participants had a serum sample, with a second sample collected from cases only. Sera were analysed for anti-streptolysin O (ASO) and anti-DNase-B (ADB) antibodies.Results: Healthy Māori and Pacific children had higher GAS antibody titres than healthy European/Other children. Children with GAS-positive sore throat had the highest mean ASO titres and children with GAS-positive skin infection had the highest mean ADB titres. When a two-fold increase or an upper limit of normal cut-off (ASO 450 IU/ml, ADB 400 U/ml) was applied to titres from children with GAS-positive sore throat, 62.1% were classified as having serologically confirmed GAS pharyngitis and 37.9% had GAS detected without serological response.Conclusions: Elevated ASO titres were associated with GAS pharyngitis and elevated ADB titres were associated with GAS skin infections in New Zealand children. Higher ASO/ADB titres in healthy Māori and Pacific children could indicate a greater prior exposure to GAS infections. [ABSTRACT FROM AUTHOR]

Postpartum pyrexia complicates 5% of pregnancies, with an infective cause identified in 50% of cases. Sepsis occurs when an infective cause results in multi-organ dysfunction and this accounts for a significant proportion of maternal deaths. The most common site of sepsis is the genital tract. It is also important to consider non-infective causes amongst the differential diagnosis. In the following article infective and non-infective causes are discussed together with relevant investigations and management. [ABSTRACT FROM AUTHOR]

Streptococcus pyogenes (S. pyogenes) is a Gram-positive bacteria which causes a spectrum of diseases ranging from asymptomatic infection to life-threatening sepsis. Studies report up to 2000 times greater risk of invasive S. pyogenes disease in close contacts of index cases within 30-days of symptom onset. Despite this, there is variability in the management of asymptomatic carriage of S. pyogenes and those at risk of secondary cases of invasive S. pyogenes infection. Our systematic review assessed the efficacy of different antibiotic regimens used for eradication of S. pyogenes from the pharynx in asymptomatic individuals. We searched Pubmed, EMBASE (1974-), OVID Medline (1948-) and the Cochrane CENTRAL registry. We included randomised controlled trials (RCTs) with asymptomatic participants with >50% with pharyngeal cultures positive with S. pyogenes at baseline. Only studies with microbiological methods including culture (+/- polymerase chain reaction, PCR) were included. We included studies published in English. Each included study was assessed by two independent reviewers for data extraction and risk of bias. Of 1166 unique records identified, three RCTs were included in the review. Two of the three included RCTs found oral clindamycin for 10-days was the most efficacious regimen, compared to intramuscular benzathine penicillin G followed by 4 days of oral rifampicin, or monotherapy using benzathine penicillin, phenoxymethylpenicillin or erythromycin. Two RCTs were assessed as being at high risk of bias, with the third study demonstrating low/some risk of bias. Current available evidence for the optimal antibiotic in eradicating pharyngeal S. pyogenes carriage is limited. Future RCTs should include penicillin, first-generation cephalosporins, rifampicin, macrolides (such as azithromycin) and clindamycin. • We included three studies which compared efficacy of antibiotics in S. pyogenes carriage clearance. • Clindamycin (ten-day course) was most efficacious in S. pyogenes carriage clearance. • Benzathine penicillin/ rifampicin combination was the second most efficacious regimen. • Future RCTs are needed to compare efficacy of antimicrobials for S. pyogenes clearance. [ABSTRACT FROM AUTHOR]

Throat infections, referred to as pharyngitis, are most commonly of viral origin; however, bacterial pharyngitis does occur, in which case group A streptococci (GAS) is the most observed causative pathogen. Regardless of the aetiology, pharyngitis is typically a self-limiting condition. Viral cases are managed by providing symptomatic treatment of inflammation and pain. GAS is managed with antimicrobials, after a Centor Criteria score has been calculated and a throat swab or rapid antigen test performed, should it be indicated. The biggest concern with GAS is the associated complications such as acute rheumatic fever, which enforces the importance of an accurate diagnosis. [ABSTRACT FROM AUTHOR]

Group A Streptococci (GAS), also known as "flesh-eating bacteria," can cause a life-threatening systemic infection called streptococcal toxic shock syndrome (STSS). We report a case of GAS infection that initially manifested as bilateral prominent auricular edema in a patient who had received treatment for maxillary cancer. A 42-year-old man was referred to our department for evaluation of prominent swelling of both ears with fever. Examination revealed bilateral painless auricular swelling with prominent edema and epithelial sacculation. Laboratory dates showed a marked inflammatory reaction. Various virus tests were negative, and computed tomography (CT) also denied phlegmone in systemic inflammation. The authors empirically start administration of intravenous antibiotics. Two days later, GAS was detected from the blood culture, and the patient received a final diagnosis of GAS infection but the disease did not extend to STSS. As CT imaging revealed the possibility of osteomyelitis of the upper jaw, broad-spectrum antibiotics were administered for 4 weeks. All symptoms, including epithelial sacculation of both auriculae, completely disappeared with the resolution of GAS. Moreover, a blast crisis in osteomyelitis was never detected to data. Early positive results from blood culture and early initiation of broad-spectrum antibiotic therapy prevented the development of STSS and necrotizing fasciitis. In the present report, epithelial sacculation of the auricula indirectly contributed to the early diagnosis of STSS. [ABSTRACT FROM AUTHOR]

Pediatric catatonia is a complex entity that is easily missed in the hospital setting and seldom reported in the literature. Here, we present the case of a 6-year-old previously healthy female patient who was initially thought to have intractable delirium secondary to disseminated Group A streptococcus (GAS) infection. Careful examination, utilization of the Pediatric Catatonia Rating Scale, and lorazepam challenge were key to elucidating the diagnosis. While GAS is most often associated with pediatric acute-onset neuropsychiatric syndrome (PANS) in the child and adolescent population, we reviewed the limited literature to suggest a mechanism by which it can lead to catatonia. Further systematic study of catatonia in the pediatric population is warranted to better understand pathogenesis and long-term neuropsychiatric outcomes. [ABSTRACT FROM AUTHOR]

Background: Streptococcal Toxic Shock Syndrome (STSS) is a serious condition that can arise from streptococcal postpartum endometritis. It is associated with a substantial increase in mortality rate and can rarely result in multiorgan infarction. Early recognition plays a vital role in patients' outcome. Objective: To report a case of complicated STSS and review the literature for previous case reports of streptococcal postpartum endometritis to determine if STSS diagnostic criteria (published by the Centers for Disease Control and Prevention) were fulfilled. Case presentation: This is a 41-year-old woman who presented 5 days after an uncomplicated vaginal delivery with endometritis complicated by invasive group A β-hemolytic streptococcus (GAS) infection and confirmed toxic shock syndrome. The patient was initially admitted to the critical care unit due to hemodynamic compromise requiring intravenous (IV) fluids, IV antibiotic therapy with penicillin and clindamycin, and IV immunoglobulin therapy. The patient subsequently developed multi-organ infarctions, acute respiratory distress syndrome requiring noninvasive respiratory support, and severe reactive arthritis. Literature review revealed 15 case reports of GAS postpartum endometritis, five met criteria for confirmed STSS. One patient died from severe septic shock leading to cardiopulmonary arrest. Thirteen out of 15 cases of postpartum endometritis occurred after uncomplicated vaginal delivery. Conclusion: STSS is a serious and possibly fatal medical condition that requires early diagnosis and treatment to prevent poor patient outcomes and death. Careful consideration to the patient's postpartum clinical presentation with the implementation of an intradisciplinary approach should be utilized. [ABSTRACT FROM AUTHOR]

En France, plus de 9 millions d'angines sont diagnostiquées par an dont la majorité est d'origine virale et ne nécessite pas d'antibiothérapie. Le pharmacien d'officine est habilité à réaliser le dépistage de l'angine à streptocoque du groupe A en utilisant un test rapide. La réalisation de ce test valorise sa mission de santé publique et contribue à la lutte contre l'antibiorésistance. In France, more than 9 million tonsillitis/pharyngitis are diagnosed each year. Majority of them are of viral origin and do not require antibiotic therapy. Today, the pharmacist can screen group A streptococcus tonsillitis/pharyngitis by using a rapid test. Carrying out this test enhances his public health mission and contributes to the control of antibiotic resistance. [ABSTRACT FROM AUTHOR]

• Three cases of puerperal sepsis with Group A Streptococcus are described. • The same emm type was found in throat cultures of their asymptomatic spouses. • Identical strains found in asymptomatic households probably rules out HAI. • We suggest considering adding screening households as a part of HAI investigations. • This may simplify in-hospital epidemiologic investigations of suspected outbreaks. Invasive group A streptococcal (iGAS) infection in the peripartum setting is a rare but devastating disease occasionally occurring as a health care–associated infection (HAI). Current guidelines suggest enhanced surveillance and streptococcal isolate storage after a single case of iGAS, as well as a full epidemiological investigation that includes screening health care workers (HCWs) from several sites after 2 cases. Current guidelines do not recommend routine screening of household members of a patient with iGAS. We conducted studies of 3 patients with iGAS puerperal sepsis and related epidemiologic and molecular investigations. Identical GAS emm gene types were found in pharyngeal cultures of 3 asymptomatic spouses of patients with iGAS puerperal sepsis. HCWs screened negative for GAS, and emm typing indicated that other iGAS cases from this hospital were sporadic and not related to the puerperal cases. The concurrent presence of the same emm type in a household member practically excludes the option of an inadvertent HAI or facility outbreak. Hence, we suggest that screening close family members for asymptomatic GAS carriage should be performed early as a part of infection prevention measures, as doing so would have significant utility in saving time and resources related to a full epidemiological inquiry. [ABSTRACT FROM AUTHOR]

An outbreak of an uncommon emm type (emm66.0) of group A streptococcus (GAS) occurred in England and Wales between January 2016 and May 2017, involving 52 individuals who were homeless or injecting drugs users. In order to investigate the outbreak, epidemiological and network analysis were performed; moreover 55 isolates (32 outbreak, 5 non-outbreak and 13 historical - 2005-2015) were tested with whole genome sequencing (WGS), antimicrobial resistance determination, Bayesian evolutionary analysis (BEAST). Forty one isolates (including 32 outbreak strains) belonged to a single emm66.0 clade (average SNP difference 6.6; range 0-16 SNPs) separate from the other isolates and two strains previously considered part of the outbreak (SNP average: 5876; range 93-8417 SNPs). Antibiotic resistance was not detected in the outbreak clone. No common source of infection was identified. WGS confirmed expansion of an emm66.0 clone in a hard-to-reach population and enabled refinement of the initial case definition. [ABSTRACT FROM AUTHOR]

Copyright of RPDI - Revista Portuguesa de Doenças Infecciosas is the property of Sociedade Portuguesa de Doencas Infecciosas e Microbiologia Clinica and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Superantigens are ubiquitous within the Streptococcus pyogenes genome, which suggests that superantigen-mediated T-cell activation provides a significant selective advantage. S. pyogenes can carry a variable complement of the 11 known superantigens. We have identified two novel S. pyogenes superantigens, denoted speQ and speR, adjacent to each other in the core-chromosome of isolates belonging to eleven different emm-types. Although distinct from other superantigens, speQ and speR were most closely related to speK and speJ, respectively. Recombinant SPEQ and SPER were mitogenic towards human peripheral blood mononuclear cells at ng/ml concentrations, and SPER was found to be more mitogenic than SPEQ. [ABSTRACT FROM AUTHOR]

Background: Outbreaks of group A streptococcus (GAS) infections may occur in healthcare settings. Transmission to patients is sometimes linked to colonized healthcare workers (HCWs) and/or a contaminated environment.Aim: To describe the investigation and control of an outbreak of healthcare-associated GAS on an elderly care medical ward, over six months.Methods: Four patients developed septicaemia due to GAS infection without a clinically obvious site of infection. The outbreak team undertook an investigation involving a retrospective review of GAS cases, prospective case finding, HCW screening and environmental sampling using both swabs and settle plates. Immediate control measures included source isolation and additional cleaning of the ward environment with a chlorine disinfectant and hydrogen peroxide.Findings: Prospective patient screening identified one additional patient with throat GAS carriage. Settle plate positivity for GAS was strongly associated with the presence of one individual HCW on the ward, who was subsequently found to have GAS perineal carriage. Contamination of a fabric-upholstered chair in an office adjacent to the ward, used by the HCW, was also detected. In total, three asymptomatic HCWs had throat GAS carriage and one HCW had both perineal and throat carriage. All isolates were typed as emm 28.Conclusion: This is the first outbreak report demonstrating the use of settle plates in a GAS outbreak investigation on a medical ward, to identify the likely source of the outbreak. Based on this report we recommend that both throat and perineal sites should be sampled if HCW screening is undertaken during an outbreak of GAS. Fabric, soft furnishings should be excluded from clinical areas as well as any adjacent offices because pathogenic bacteria such as GAS may contaminate this environment. [ABSTRACT FROM AUTHOR]

Graphical abstract Abstract Peptide-based vaccines have the potential to overcome the limitations of classical vaccines; however, their use is hampered by a lack of carriers and adjuvants suitable for human use. In this study, an efficient self-adjuvanting peptide vaccine delivery system was developed based on the ionic interactions between cationic trimethyl chitosan (TMC) and a peptide antigen coupled with synthetically defined anionic α-poly-(l -glutamic acid) (PGA). The antigen, possessing a conserved B-cell epitope derived from the group A streptococcus (GAS) pathogen and a universal T-helper epitope, was conjugated to PGA using cycloaddition reaction. The produced anionic conjugate formed nanoparticles (NP-1) through interaction with cationic TMC. These NP-1 induced higher systemic and mucosal antibody titers compared to antigen adjuvanted with standard mucosal adjuvant cholera toxin B subunit or antigen mixed with TMC. The produced serum antibodies were also opsonic against clinically isolated GAS strains. Further, a reduction in bacterial burden was observed in nasal secretions, pharyngeal surface and nasopharyngeal-associated lymphoid tissue of mice immunized with NP-1 in GAS challenge studies. Thus, conjugation of defined-length anionic polymer to peptide antigen as a means of formulating ionic interaction-based nanoparticles with cationic polymer is a promising strategy for peptide antigen delivery. Statement of Significance A self-adjuvanting delivery system is required for peptide vaccines to enhance antigen delivery to immune cells and generate systemic and mucosal immunity. Herein, we developed a novel self-adjuvanting nanoparticulate delivery system for peptide antigens by combining polymer-conjugation and complexation strategies. We conjugated peptide antigen with anionic α-poly-(l -glutamic acid) that in turn, formed nanoparticles with cationic trimethyl chitosan by ionic interactions, without using external crosslinker. On intranasal administration to mice, these nanoparticles induced systemic and mucosal immunity, at low dose. Additionally, nanoparticles provided protection to vaccinated mice against group A streptococcus infection. Thus, this concept should be particularly useful in developing nanoparticles for the delivery of peptide antigens. [ABSTRACT FROM AUTHOR]

Pyrexia in the postpartum period is a common finding. Differentiating between potentially fatal and benign causes is fundamental in reducing the mortality rate from sinister causes such as sepsis. Sepsis, most frequently originating from the genital tract, is the commonest cause of postpartum pyrexia and is a frequent cause of maternal death and morbidity world-wide. The UK has experienced a significant reduction in the death rate secondary to sepsis following a national campaign directed at improving the speed with which it is diagnosed and treated. Non-infective causes of postpartum pyrexia include venous thromboembolism and epidural catheter use for pain relief in labour. In the following article, we shall focus on the pathophysiology of pyrexia and the diagnosis and management of postpartum sepsis. Non-infective causes will also be discussed, in addition to their management. [ABSTRACT FROM AUTHOR]

Objectives: Streptococcal serology provides evidence of prior Group A Streptococcus (GAS) exposure, crucial to the diagnosis of acute rheumatic fever (ARF) and post-streptococcal glomerulonephritis. However, current tests, which measure anti-streptolysin-O and anti-DNaseB antibodies, are limited by false positives in GAS endemic settings, and incompatible methodology requiring the two tests to be run in parallel. The objective was to improve streptococcal serology by combining the novel GAS antigen, SpnA, with streptolysin-O and DNaseB in a contemporary, bead-based immunoassay.Methods: Recombinant streptolysin-O, DNAseB and SpnA were conjugated to polystyrene beads with unique fluorescence positions so antibody binding to all three antigens could be detected simultaneously by cytometric bead array. Multiplex assays were run on sera collected in three groups: ARF; ethnically matched healthy children; and healthy adults.Results: The ability of the antigens to detect a previous GAS exposure in ARF was assessed using the 80th centile of the healthy children group as cut-off (upper limit of normal). SpnA had the highest sensitivity at 88%, compared with 75% for streptolysin-O and 56% for DNaseB.Conclusions: SpnA has favorable immunokinetics for streptococcal serology, and can be combined with anti-streptolysin-O and anti-DNaseB in a multiplex format to improve efficiency and accuracy. [ABSTRACT FROM AUTHOR]

Background: The burden of disease caused by group A streptococcus (GAS) in Africa is largely unknown. The aim of this study was to determine the incidence of invasive (iGAS) and non-invasive GAS (non-iGAS) infections in patients attending the public health sector of South Africa. Methods:iGAS and non-iGAS infection was defined as GAS isolated in culture from sterile and non-sterile sites respectively. Using annual census data, we calculated incidence rates (IR) ofiGAS and non-iGAS infection by reviewing cases from the National Health Laboratory Service (NHLS) database derived from the 9 provinces of South Africa between 2003 and 2015. Results: About 50% of the samples were collected in the Eastern Cape province which had data for all the years under observation; missing data from the other eight provinces precluded analysis of annual incidence. A multi-modal distribution of 5 256 GAS cases was observed in the Eastern Cape province.iGAS cases (n = 428) showed an annual mean IR of 0.48 (Range: 0.15–1.12) cases per 105per year (py) with a marginal decrease from 2003 to 2015 (Rate Difference (RD), 0.23/105py; 95% CI: 0.02–0.44/105py). The mean annual IR for non-iGAS infection (n = 4828) was 5.48 (Range: 0.19–11.55) cases/105py; IR showed a decrease (RD, 11.36/105py; 95% CI: 10.53–12.19/105py). The Mann-Kendall test and the Theil-Sen estimator showed a decreasing trend in the incidence of non-iGAS infection (p = 0.002) over the study period. Conclusions: The incidence of non-iGAS infection in the Eastern Cape province of South Africa declined from 2003 to 2015. The trends from the Eastern Cape and incomplete data from other provinces indicate the need for a detailed prospective evaluation of GAS infection in South Africa to verify this trend and provide information for planning appropriate interventions. [ABSTRACT FROM PUBLISHER]

Thyroid storm is an endocrine emergency associated with high mortality rates, especially in hospitalized populations. Infection serves as an exceedingly common trigger for the development of thyrotoxicosis. We present a rare case of a 24-year-old woman who developed acute thyrotoxicosis secondary to group A Streptococcus throat infection. The patient received a combination of thionamides, antibiotics, glucocorticoid, beta-blocker, and iodine preparation that resulted in the resolution of her symptoms. [ABSTRACT FROM AUTHOR]

Streptococcus pyogenes (group A Streptococcus ) is a clinically important gram-positive bacterium that causes severe diseases with high mortality. Spontaneous mutations in genes encoding the CovR/CovS two-component regulatory system have been shown to derepress expression of virulence factors and are significantly associated with invasiveness of infections. Sensor kinase CovS senses environmental signals and then regulates the levels of phosphorylated CovR. In addition, CovS is responsible for survival of group A Streptococcus under acidic stress. How this system regulates the expression of CovR-controlled genes under acidic stress is not clear. This study shows that the expression of CovR-controlled genes, including hasA , ska , and slo , is repressed under acidic conditions by a CovS-dependent mechanism. Inactivation of CovS kinase activity or CovR protein phosphorylation derepresses the transcription of these genes under acidic conditions, suggesting that the phosphorylation of CovR is required for the repression of the CovR-controlled genes. Furthermore, the promoter activity of the covR / covS operon (p cov ) was upregulated after 15 min of incubation under acidic conditions. Replacement of p cov with a constitutively activated promoter abrogated the acidic-stress-dependent repression of the genes, indicating that the pH-dependent p cov activity is directly involved in the repression of CovR-controlled genes. In summary, the present study shows that inactivation of CovS not only derepresses CovR-controlled genes but also abrogates the acidic-stress-dependent repression of the genes; these phenomena may significantly increase bacterial virulence during infection. [ABSTRACT FROM AUTHOR]

Aims: A prospective observational study was conducted in Royal Marines (RM) recruits to investigate throat carriage of group A Streptococcus (GAS) and incidence of soft tissue infections.Methods: 1012 RM recruits were followed through a 32-week training programme, with throat swabs being obtained in weeks 1, 6, 15, and 32. Alongside a separate cohort of 46 RM Young Officers (YO) undergoing training were sampled in parallel.Results: Carriage of group A Streptococcus was detected in only 5/1012 (0.49%) recruits at the beginning of training and remained low throughout training. There was no association between GAS carriage and development of soft tissue infection. There was no carriage of GAS in the smaller YO cohort at the start of training, (0/46). At week 6, a surge in GAS carriage was detected in 8/46 (17%) YO, that could be ascribed to a cluster of GAS genotype emm83.Conclusions: Asymptomatic GAS carriage is very infrequent among young adults in England and this should be borne in mind when considering the relevance of a positive throat swab result in symptomatic patients or outbreaks. Despite low prevalence, there is however potential for GAS to rapidly and transiently disseminate among adults during outbreaks. [ABSTRACT FROM AUTHOR]

Background: Group A streptococcal bloodstream infection is the most common presentation of invasive group A streptococcal disease. We sought to determine the impact of immunosuppression on severity of disease and clinical outcomes.Methods: This retrospective review of 148 patients with at least one positive blood culture for Streptococcus pyogenes from 1/2003 to 3/2013 compared immunocompromised patients with those with no immunocompromise in regards to development of severe complications and mortality.Results: Twenty-five patients (17%) were immunocompromised; 123 were not. Skin and soft tissue infection occurred in 60% of immunocompromised vs. 38% of non-immunocompromised patients, p = .04. Necrotizing fasciitis and septic shock were significantly more common in immunocompromised patients, p < .0001 and .028, respectively. Mortality at 30 days was 32% in immunocompromised patients vs. 16% in non-immunocompromised patients, p = .05.Conclusion: Patients who are immunocompromised are more likely to develop necrotizing fasciitis and septic shock as complications of group A streptococcal bacteremia and have a higher mortality rate than patients who are not immunocompromised. [ABSTRACT FROM AUTHOR]

Objectives: Besides group A streptococcus (GAS), microbial causes of pharyngitis in children are not well known. We aimed to document the viral and bacterial aetiology of pharyngitis and to assess the pathogenic role of viruses by determining the myxovirus resistance protein A (MxA) in the blood as a marker of interferon response.Methods: In this prospective observational study, throat swabs and blood samples were collected from children (age 1-16 years) presenting to the emergency department with febrile pharyngitis. Microbial cause was sought by bacterial culture, polymerase chain reaction, and serology. Blood MxA level was determined.Results: A potential pathogen was detected in 88% of 83 patients: GAS alone in 10%, GAS and viruses in 13%, group C or G streptococci alone in 2% and together with viruses in 3%, and viruses alone in 59% of cases. Enteroviruses, rhinoviruses, and adenoviruses were the most frequently detected viruses. Blood MxA levels were higher in children with viral (880 [245-1250] μg/L; median [IQR]) or concomitant GAS-viral (340 [150-710] μg/L) than in those with sole GAS (105 [80-160] μg/L) infections.Conclusions: Detection of respiratory viruses simultaneously with elevated blood MxA levels supports the causative role of viruses in the majority of children with pharyngitis. [ABSTRACT FROM AUTHOR]

Trace metals such as Fe, Mn, Zn and Cu are essential for various biological functions including proper innate immune function. The host immune system has complicated and coordinated mechanisms in place to either starve and/or overload invading pathogens with various metals to combat the infection. Here, we discuss the roles of Fe, Mn and Zn in terms of nutritional immunity, and also the roles of Cu and Zn in metal overload in relation to the physiology and pathogenesis of two human streptococcal species, Streptococcus pneumoniae and Streptococcus pyogenes. S. pneumoniae is a major human pathogen that is carried asymptomatically in the nasopharynx by up to 70% of the population; however, transition to internal sites can cause a range of diseases such as pneumonia, otitis media, meningitis and bacteraemia. S. pyogenes is a human pathogen responsible for diseases ranging from pharyngitis and impetigo, to severe invasive infections. Both species have overlapping capacity with respect to metal acquisition, export and regulation and how metal homeostasis relates to their virulence and ability to invade and survive within the host. It is becoming more apparent that metals have an important role to play in the control of infection, and with further investigations, it could lead to the potential use of metals in novel antimicrobial therapies. [ABSTRACT FROM AUTHOR]

Group A streptococcus (GAS), an exclusively human pathogen, causes a wide range of diseases ranging from trivial to life threatening. Treatment of infection is often ineffective following entry of bacteria into the bloodstream. To date, there is no vaccine available against GAS. In this study, cationic liposomes encapsulating lipopeptide-based vaccine candidates against GAS have been employed for intranasal vaccine delivery. Cationic liposomes were prepared with dimethyldioctadecylammonium bromide (DDAB) using the film hydration method. Female Swiss mice were immunized intranasally with the liposomes. In contrast to unmodified peptides, lipopeptides entrapped by liposomes induced both mucosal and systemic immunity, IgA and IgG (IgG1 and IgG2a) production in mice, respectively. High levels of antibody (IgA and IgG) titres were detected even five months post immunization. Thus, the combination of lipopeptides and liposomes generates a very promising delivery system for intranasal vaccines. Statement of Significance Group A streptococcus, causing rheumatic heart diseases, kills approximately half a million people annually. There is no vaccine available against the infection. Mucosal immunity is vital in ensuring an individual is protected as this gram positive bacteria initially colonizes at the throat. Herein, we demonstrated that lipopeptides entrapped by liposomes induced both mucosal and systemic immunity. High levels of antibody (IgA and IgG) titres were detected even five months post immunization and lead vaccine candidate was able to induce humoral immune responses even after single immunization. Thus, the combination of lipopeptides and liposomes generates a very promising delivery system for intranasal vaccines. [ABSTRACT FROM AUTHOR]

Streptococcal pharyngitis continues to be one of the most common childhood illnesses throughout the world. Recent evidence indicates an increased incidence of group A Streptococcal (GAS) infections, which is a significant cause of mortality and morbidity on the global scale. The objective of this study was to determine prevalence of group A Streptococcus infection among primary schoolchildren in Mbulu district, northern Tanzania. This study was carried out in five primary schools, namely Mangisha, Gunyoda, Kainam, Hyloto and Tsaayo. GAS pharyngitis was diagnosed clinically and confirmed by laboratory investigation using a rapid test. A total of 320 study participants were recruited in the study. Overall, more than half (53.8%) of the children were females. The overall prevalence of Group a Streptococcal infection was 6.9% (95%CI [4.4-10.2]). The highest frequency of GAS infection was observed among children at Hyloto primary school (14.3%) while, none of the children in Tsaayo had GAS infection. This study potentially indicates that group A Streptococcal infection prevalent among schoolchildren in Mbulu district calling for the need of education to create awareness of the condition in the community. [ABSTRACT FROM AUTHOR]

There has been an increasing incidence worldwide of invasive group A streptococcal disease in pregnancy and the puerperal period over the past 30 years. Group A Streptococcus (GAS) was identified as the major cause of maternal morbidity and mortality from sepsis before the identification that hand washing techniques could prevent the transmission of the bacteria. Hand washing remains the cornerstone of prevention as transmission can occur directly from an asymptomatic colonized healthcare provider, other patients, or a community-acquired source. Pregnancy and the puerperal period are associated with significant maternal physiologic changes that must be identified and clarified to identify signs and symptoms of GAS so that treatment can be initiated at the earliest moment. Treatment of group A streptococcal sepsis follows the guidelines developed under the Surviving Sepsis Campaign model. Maternal outcomes are improved by identifying risk factors and working with the perinatal team to implement rapid intervention. Even with prompt treatment of invasive group A Streptococcus, it remains the most common cause of infection that results in severe maternal morbidity and death in the world. [ABSTRACT FROM AUTHOR]

Objectives: Despite over a century of research and the careful scrutiny of many promising targets, there is currently no vaccine available for the prevention of Streptococcus pyogenes infection. Through analysis of the protective, anti-streptococcal components of pooled human immunoglobulin, we previously identified ten highly conserved and invariant S. pyogenes antigens that contribute to anti-streptococcal immunity in the adult population. We sought to emulate population immunity to S. pyogenes through a process of active vaccination, using the antigens targeted by pooled human immunoglobulin.Methods: Seven targets were produced recombinantly and mixed to form a multicomponent vaccine (Spy7). Vaccinated mice were challenged with S. pyogenes isolates representing four globally relevant serotypes (M1, M3, M12 and M89) using an established model of invasive disease.Results: Vaccination with Spy7 stimulated the production of anti-streptococcal antibodies, and limited systemic dissemination of M1 and M3 S. pyogenes from an intramuscular infection focus. Vaccination additionally attenuated disease severity due to M1 S. pyogenes as evidenced by reduction in weight loss, and modulated cytokine release.Conclusion: Spy7 vaccination successfully stimulated the generation of protective anti-streptococcal immunity in vivo. Identification of reactive antigens using pooled human immunoglobulin may represent a novel route to vaccine discovery for extracellular bacteria. [ABSTRACT FROM AUTHOR]

Impetigo is a contagious skin disease caused by Staphylococcus aureus and Streptococcus pyogenes. Without treatment, impetigo may be recurrent, develop into severe disease, or have serious, life-threatening sequelae. Standard treatment consists of topical or systemic antibiotic therapy (depending on severity), however, due to antibiotic resistance some therapies are increasingly ineffective. In this study we evaluated the potential for honey as an alternative treatment for impetigo. A broth microdilution assay in 96-well microtitre trays was used to determine the minimum inhibitory concentrations (MICs) of six monofloral honeys (jarrah, marri, red bell, banksia, wandoo, and manuka), a multifloral honey and artificial honey against S. aureus (n = 10), S. pyogenes (n = 10), and coagulase-negative staphylococci (CoNS) (n = 10). The optical density (OD) of all microtitre tray wells was also determined before and after assay incubation to analyse whether sub-MIC growth inhibition occurred. Jarrah, marri, red bell, banksia, and manuka honeys were highly effective at inhibiting S. aureus and CoNS, with MIC 50 values ranging from 4 to 8% w/v honey. S. pyogenes was also inhibited by these same honeys, albeit at higher concentrations (8–29% w/v). Wandoo and multifloral honeys had the least antibacterial activity with MICs of >30% (w/v) for all isolates. However, OD data indicated that sub-MIC concentrations of honey were still partially restricting bacterial growth. Our pre-clinical data indicate that honey may be a potential therapeutic agent for the routine treatment of mild impetigo, and we suggest that clinical trials would be appropriate to further investigate this. • Honey is able to inhibit the growth of impetigo-causing bacteria. • Commensal Staphylococcus spp. are similarly inhibited by honey. • Results support honey as a potential clinical antibacterial agent. [ABSTRACT FROM AUTHOR]