Skip to main content

Advertisement

SpringerLink
Log in

Epidemiological features of invasive and noninvasive group A streptococcal disease in the Netherlands, 1992–1996

  • Article
  • Published:
European Journal of Clinical Microbiology and Infectious Diseases Aims and scope Submit manuscript

Abstract

A prospective, nationwide, laboratory-based surveillance of invasive group A streptococcal infections was conducted in the Netherlands from 1992 through 1996. Clinical and demographic data were obtained and all isolates were T/M typed. All noninvasive group A streptococcal isolates were registered from 1994 through 1996. A total of 880 patients with invasive streptococcal disease were identified. The annual incidence was found to be 2.2 per 100,000. Predominant M types were M1 (21%), M3 (11%), M6 (5%), M12 (5%), and M28 (8%). Particular age and M-type distributions were observed in different clinical entities. The case-fatality rate was 18% overall, but it reached 59% among cases of toxic shock-like syndrome. Older age, necrotizing fasciitis, sepsis without focus, pneumonia, infection with type M1 or M3 strains, and underlying cardiopulmonary disease were associated with fatality. A total of 10,105 patients with noninvasive group A streptococcal disease were registered. These patients differed significantly from patients with invasive disease with regard to age distribution and primary foci of infection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Bisno AL (1990) Nonsuppurative poststreptococcal sequelae: rheumatic fever and glomerulonephritis. In: Mandell GL, Bennett JE, Dolin R (eds) Principles and practice of infectious diseases. Churchill Livingstone, New York, pp 1799–1810

  2. O’Brien KL, Beall B, Barrett NL, Cieslak PR, Reingold A, Farley MM, Danila R, Zell ER, Facklam R, Schwartz B, Schuchat A (2002) Epidemiology of invasive group A streptococcus disease in the United States, 1995–1999. Clin Infect Dis 35:268–276

    PubMed  Google Scholar 

  3. Sharkawy A, Low DE, Saginur R, Gregson D, Schwartz B, Jessamine P, Green K, McGeer A (2002) Severe group A streptococcal soft-tissue infections in Ontario: 1992–1996. Clin Infect Dis 34:454–460

    Article  PubMed  Google Scholar 

  4. Cone LA, Woodard DR, Schlievert PM, Tomory GS (1987) Clinical and bacteriologic observations of a toxic shock-like syndrome due to Streptococcus pyogenes. N Engl J Med 317:146–149

    CAS  PubMed  Google Scholar 

  5. Gaworzewska E, Colman G (1988) Changes in the pattern of infection caused by Streptococcus pyogenes. Epidemiol Infect 100:257–269

    CAS  PubMed  Google Scholar 

  6. Martin GS, Mannino DM, Eaton S, Moss M (2003) The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med 348:1546–1554

    Article  PubMed  Google Scholar 

  7. Schwartz B, Facklam RR, Breiman RF (1990) Changing epidemiology of group A streptococcal infection in the USA. Lancet 336:1167–1171

    CAS  PubMed  Google Scholar 

  8. Bisno AL (1991) Group A streptococcal infections and acute rheumatic fever. N Engl J Med 325:783–793

    CAS  PubMed  Google Scholar 

  9. Colman G, Tanna A, Efstratiou A, Gaworzewska ET (1993) The serotypes of Streptococcus pyogenes present in Britain during 1980–1990 and their association with disease. J Med Microbiol 39:165–178

    CAS  PubMed  Google Scholar 

  10. Ferrieri P (1991) Microbiological features of current virulent strains of group A streptococci. Pediatr Infect Dis J 10:S20–S24

    CAS  PubMed  Google Scholar 

  11. Hauser AR, Stevens DL, Kaplan EL, Schlievert PM (1991) Molecular analysis of pyogenic exotoxins from Streptococcus pyogenes isolates associated with toxic shock-like syndrome. J Clin Microbiol 29:1562–1567

    CAS  PubMed  Google Scholar 

  12. Johnson DR, Stevens DL, Kaplan EL (1992) Epidemiologic analysis of group A streptococcal serotypes associated with severe systemic infections, rheumatic fever, or uncomplicated pharyngitis. J Infect Dis 166:374–382

    CAS  PubMed  Google Scholar 

  13. Musser JM, Hauser AR, Kim MH, Schlievert PM, Nelson K, Selander RK (1991) Streptococcus pyogenes causing toxic-shock-like syndrome and other invasive diseases: clonal diversity and pyrogenic exotoxin expression. Proc Natl Acad Sci USA 88:2668–2672

    CAS  PubMed  Google Scholar 

  14. Reichardt W, Muller-Alouf H, Alouf JE, Kohler W (1992) Erythrogenic toxins A, B and C: occurrence of the genes and exotoxin formation from clinical Streptococcus pyogenes strains associated with streptococcal toxic shock-like syndrome. FEMS Microbiol Lett 79:313–322

    CAS  PubMed  Google Scholar 

  15. Stromberg A, Romanus V, Burman LG (1991) Outbreak of group A streptococcal bacteremia in Sweden: an epidemiologic and clinical study. J Infect Dis 164:595–598

    CAS  PubMed  Google Scholar 

  16. Johnson DR, Wotton JT, Shet A, Kaplan EL (2002) A comparison of group A streptococci from invasive and uncomplicated infections: are virulent clones responsible for serious streptococcal infections? J Infect Dis 185:1586–1595

    Article  PubMed  Google Scholar 

  17. Mascini EM, Jansze M, Schellekens JF, Musser JM, Faber JA, Verhoef-Verhage LA, Schouls L, van Leeuwen WJ, Verhoef J, van Dijk H (2000) Invasive group A streptococcal disease in the Netherlands: evidence for a protective role of anti-exotoxin A antibodies. J Infect Dis 181:631–638

    Google Scholar 

  18. Schellekens JF, Schouls L, van Silfhout A, Elzenaar K, Brunings H, Blokpoel M, Top J, van Leeuwen WJ (1994) Invasieve infecties door beta-haemolytische Streptokokken Lancefield Groep A (Streptococcus pyogenes) in Nederland, 1992–1993. Report No. 253631001 of the National Institute of Public Health and Environmental Protection (RIVM). RIVM, Bilthoven

  19. Schellekens JF, Schouls LM, van Pelt W, Esveld M, van Leeuwen WJ (1998) Group A streptococci: a change in virulence? Neth J Med 52:209

    Article  CAS  PubMed  Google Scholar 

  20. The Working Group on Severe Streptococcal Infections (1993) Defining the group A streptococcal toxic shock syndrome. Rationale and consensus definition. J Am Med Assoc 269:390–391

    Article  Google Scholar 

  21. Griffith F (1934) The serologic classification of Streptococcus pyogenes. J Hyg Camb 34:542–584

    Google Scholar 

  22. Kaufhold A, Podbielski A, Baumgarten G, Blokpoel M, Top J, Schouls L (1994) Rapid typing of group A streptococci by the use of DNA amplification and non-radioactive allele-specific oligonucleotide probes. FEMS Microbiol Lett 119:19–25

    Article  CAS  PubMed  Google Scholar 

  23. Hosmer DW, Lemeshow S (1989) Applied logistic regression. Wiley, New York, pp 82–134

  24. Davies HD, McGeer A, Schwartz B, Green K, Cann D, Simor AE, Low DE (1996) Invasive group A streptococcal infections in Ontario, Canada. Ontario Group A Streptococcal Study Group. N Engl J Med 335:547–554

    CAS  PubMed  Google Scholar 

  25. Centers for Disease Control and Prevention (2002) Prevention of invasive group A streptococcal disease among household contacts of case patients and among postpartum and postsurgical patients: recommendations from the Centers for Disease Control and Prevention. Clin Infect Dis 35:950–959

    Article  PubMed  Google Scholar 

  26. Svensson N, Oberg S, Henriques B, Holm S, Kallenius G, Romanus V, Giesecke J (2000) Invasive group A streptococcal infections in Sweden in 1994 and 1995: epidemiology and clinical spectrum. Scand J Infect Dis 32:609–614

    Article  CAS  PubMed  Google Scholar 

  27. Andersen MM, Ronne T (1995) Group A streptococcal bacteraemias in Denmark 1987–1989. J Infect 31:33–37

    Article  CAS  PubMed  Google Scholar 

  28. Martin PR, Hoiby EA (1990) Streptococcal serogroup A epidemic in Norway 1987–1988. Scand J Infect Dis 22:421–429

    CAS  PubMed  Google Scholar 

  29. Bibler MR, Rouan GW (1986) Cryptogenic group A streptococcal bacteremia: experience at an urban general hospital and review of the literature. Rev Infect Dis 8:941–951

    CAS  PubMed  Google Scholar 

  30. Ispahani P, Donald FE, Aveline AJ (1988) Streptococcus pyogenes bacteraemia: an old enemy subdued, but not defeated. J Infect 16:37–46

    CAS  PubMed  Google Scholar 

  31. Muller MP, Low DE, Green KA, Simor AE, Loeb M, Gregson D, McGeer A (2003) Clinical and epidemiologic features of group A streptococcal pneumonia in Ontario, Canada. Arch Intern Med 163:467–472

    Article  PubMed  Google Scholar 

  32. Beall B, Facklam R, Hoenes T, Schwartz B (1997) Survey of emm gene sequences and T-antigen types from systemic Streptococcus pyogenes infection isolates collected in San Francisco, California; Atlanta, Georgia; and Connecticut in 1994 and 1995. J Clin Microbiol 35:1231–1235

    CAS  PubMed  Google Scholar 

  33. Hoge CW, Schwartz B, Talkington DF, Breiman RF, MacNeill EM, Englender SJ (1993) The changing epidemiology of invasive group A streptococcal infections and the emergence of streptococcal toxic shock-like syndrome. A retrospective population-based study. J Am Med Assoc 269:384–389

    Article  CAS  Google Scholar 

  34. Kiska DL, Thiede B, Caracciolo J, Jordan M, Johnson D, Kaplan EL, Gruninger RP, Lohr JA, Gilligan PH, Denny FW Jr (1997) Invasive group A streptococcal infections in North Carolina: epidemiology, clinical features, and genetic and serotype analysis of causative organisms. J Infect Dis 176:992–1000

    CAS  PubMed  Google Scholar 

  35. Lehtonen OP, Kero P, Ruuskanen O, Gaworzewska ET, Hollo O, Erkkola R, Salmi T (1987) A nursery outbreak of group A streptococcal infection. J Infect 14:263–270

    CAS  PubMed  Google Scholar 

  36. Centers for Disease Control and Prevention (2003) Outbreak of group A streptococcal pneumonia among Marine Corps recruits, California, November 1–December 20, 2002. MMWR Morb Mortal Wkly Rep 52:106–109

    PubMed  Google Scholar 

  37. Muotiala A, Saxen H, Vuopio-Varkila J (1997) Group A streptococcal outbreak of perianal infection in a day-care centre. Adv Exp Med Biol 418:211–215

    CAS  PubMed  Google Scholar 

  38. Petersen JP, Kaltoft MS, Misfeldt JC, Schumacher H, Schonheyder HC (2003) Community outbreak of perianal group A streptococcal infection in Denmark. Pediatr Infect Dis J 22:105–109

    Article  PubMed  Google Scholar 

  39. Jaffe J, Natanson-Yaron S, Caparon MG, Hanski E (1996) Protein F2, a novel fibronectin-binding protein from Streptococcus pyogenes, possesses two binding domains. Mol Microbiol 21:373–384

    Article  CAS  PubMed  Google Scholar 

  40. Natanson S, Sela S, Moses AE, Musser JM, Caparon MG, Hanski E (1995) Distribution of fibronectin-binding proteins among group A streptococci of different M types. J Infect Dis 171:871–878

    CAS  PubMed  Google Scholar 

  41. Rocha CL, Fischetti VA (1999) Identification and characterization of a novel fibronectin-binding protein on the surface of group A streptococci. Infect Immun 67:2720–2728

    CAS  PubMed  Google Scholar 

  42. Valentin-Weigand P, Talay SR, Kaufhold A, Timmis KN, Chhatwal GS (1994) The fibronectin binding domain of the Sfb protein adhesin of Streptococcus pyogenes occurs in many group A streptococci and does not cross-react with heart myosin. Microb Pathog 17:111–120

    Article  CAS  PubMed  Google Scholar 

  43. Eriksson BK, Andersson J, Holm SE, Norgren M (1998) Epidemiological and clinical aspects of invasive group A streptococcal infections and the streptococcal toxic shock syndrome. Clin Infect Dis 27:1428–1436

    CAS  PubMed  Google Scholar 

  44. Lancefield RC (1959) Persistence of type-specific antibodies in man following infection with group A streptococci. J Exp Med 110:271–292

    CAS  PubMed  Google Scholar 

  45. Basma H, Norrby-Teglund A, Guedez Y, McGeer A, Low DE, El Ahmedy O, Schwartz B, Kotb M (1999) Risk factors in the pathogenesis of invasive group A streptococcal infections: role of protective humoral immunity. Infect Immun 67:1871–1877

    CAS  PubMed  Google Scholar 

  46. Norrby-Teglund A, Pauksens K, Holm SE, Norgren M (1994) Relation between low capacity of human sera to inhibit streptococcal mitogens and serious manifestation of disease. J Infect Dis 170:585–591

    CAS  PubMed  Google Scholar 

  47. Davidson M, Parkinson AJ, Bulkow LR, Fitzgerald MA, Peters HV, Parks DJ (1994) The epidemiology of invasive pneumococcal disease in Alaska, 1986–1990, ethnic differences and opportunities for prevention. J Infect Dis 170:368–376

    CAS  PubMed  Google Scholar 

  48. Jones DM, Mallard RH (1993) Age incidence of meningococcal infection in England and Wales, 1984–1991. J Infect 27:83–88

    CAS  PubMed  Google Scholar 

  49. Bucher A, Martin PR, Hoiby EA, Halstensen A, Odegaard A, Hellum KB, Westlie L, Hallan S (1992) Spectrum of disease in bacteraemic patients during a Streptococcus pyogenes serotype M-1 epidemic in Norway in 1988. Eur J Clin Microbiol Infect Dis 11:416–426

    CAS  PubMed  Google Scholar 

  50. Ho PL, Johnson DR, Yue AW, Tsang DN, Que TL, Beall B, Kaplan EL (2003) Epidemiologic analysis of invasive and noninvasive group A streptococcal isolates in Hong Kong. J Clin Microbiol 41:937–942

    Article  CAS  PubMed  Google Scholar 

  51. Zwart S, Ruijs GJ, Sachs AP, van Leeuwen WJ, Gubbels JW, de Melker RA (2000) Beta-haemolytic streptococci isolated from acute sore-throat patients: cause or coincidence? A case-control study in general practice. Scand J Infect Dis 32:377–384

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Eijkman Winkler Institute for Medical Microbiology, Infectious Diseases and Inflammation, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands

    B. Vlaminckx, E. Mascini & J. Verhoef

  2. National Institute of Public Health and the Environment (RIVM), van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands

    W. van Pelt, L. Schouls, A. van Silfhout, C. Elzenaar & J. Schellekens

Authors
  1. B. Vlaminckx
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. W. van Pelt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L. Schouls
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. van Silfhout
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Elzenaar
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. E. Mascini
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. Verhoef
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. J. Schellekens
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. Vlaminckx.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vlaminckx, B., van Pelt, W., Schouls, L. et al. Epidemiological features of invasive and noninvasive group A streptococcal disease in the Netherlands, 1992–1996. Eur J Clin Microbiol Infect Dis 23, 434–444 (2004). https://doi.org/10.1007/s10096-004-1147-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-004-1147-z

Keywords

Search

Navigation