Epidemiological and clinical aspects of invasive group A streptococcal infections and the streptococcal toxic shock syndrome

被引:89
作者
Eriksson, BKG
Andersson, J
Holm, SE
Norgren, M
机构
[1] Huddinge Univ Hosp, Karolinska Inst, Dept Immunol Microbiol Pathol & Infect Dis, Div Infect Dis, S-14186 Huddinge, Sweden
[2] Umea Univ, Dept Clin Bacteriol, Umea, Sweden
关键词
D O I
10.1086/515012
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
In a retrospective study of invasive infections due to group A Streptococcus (GAS) in Stockholm during 1987 to 1995, the average incidence per 100,000 residents per year was 2.3, varying between 3.7 per 100,000 (in 1988) and 1.3 per 100,000 (in 1993). Incidence was 1.8 in the age group of 0-4 years but otherwise increased by age, from 0.48 in the age group of 5-14 years to 6.1 among those over 65 years of age. A review of 151 invasive episodes occurring in 1983-1995 showed cyclic increases of infections due to T1M1-serotype strains during 1986-1990 and 1993-1995. The T1M1 serotype accounted for 27 (20%) of 135 available GAS strains. Streptococcal toxic shock syndrome (STSS) developed in 19 (13%) of the 151 episodes. The case fatality rate was 11% overall but 47% among patients with STSS. In a multivariate logistic regression model, STSS was associated with a history of alcohol abuse (odds ratio [OR], 6.3; P = .004) and infection with a T1M1 strain (OR, 6.7; P = .007). Case fatality was associated with age (OR, 14.5; P = .08), immunosuppression (OR, 4.7; P = .02), and STSS (OR, 21.5; P < .0001) but not with T1M1 infection. Hypotension was significantly associated with a fatal outcome, regardless of whether STSS developed (P < .0001).
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页码:1428 / 1436
页数:9
相关论文
共 58 条
  • [1] GROUP-A STREPTOCOCCAL BACTEREMIAS IN DENMARK 1987-89
    ANDERSEN, MM
    RONNE, T
    [J]. JOURNAL OF INFECTION, 1995, 31 (01) : 33 - 37
  • [2] [Anonymous], 1990, MMWR-MORBID MORTAL W, V39, P577
  • [3] TOXIC STREP SYNDROME - A MANIFESTATION OF GROUP-A STREPTOCOCCAL INFECTION
    BARTTER, T
    DASCAL, A
    CARROLL, K
    CURLEY, FJ
    [J]. ARCHIVES OF INTERNAL MEDICINE, 1988, 148 (06) : 1421 - 1424
  • [4] BIBLER MR, 1986, REV INFECT DIS, V8, P941
  • [5] SEVERE STREPTOCOCCAL DISEASE - OBSERVATIONS DURING AN EPIDEMIC OCCURRING IN SOUTHERN NEW ENGLAND, 1958-1959
    BLACK, PH
    STOKES, J
    MCFARLAND, RB
    SWARTZ, MN
    SHARP, JT
    KUNZ, LJ
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1961, 264 (18) : 898 - +
  • [6] DEFINING THE GROUP-A STREPTOCOCCAL TOXIC SHOCK SYNDROME - RATIONALE AND CONSENSUS DEFINITION
    BREIMAN, RF
    DAVIS, JP
    FACKLAM, RR
    GRAY, BM
    HOGE, CW
    KAPLAN, EL
    MORTIMER, EA
    SCHLIEVERT, PM
    SCHWARTZ, B
    STEVENS, DL
    TODD, JK
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1993, 269 (03): : 390 - 391
  • [7] GROUP-A STREPTOCOCCAL BACTEREMIA IN A COMMUNITY TEACHING HOSPITAL - 1980-1989
    BURKERT, T
    WATANAKUNAKORN, C
    [J]. CLINICAL INFECTIOUS DISEASES, 1992, 14 (01) : 29 - 37
  • [8] A cluster of cases of streptococcal necrotizing fasciitis in Gloucestershire
    Cartwright, K
    Logan, M
    McNulty, C
    Harrison, S
    George, R
    Efstratiou, A
    McEvoy, M
    Begg, N
    [J]. EPIDEMIOLOGY AND INFECTION, 1995, 115 (03) : 387 - 397
  • [9] STREPTOCOCCAL TOXIC SHOCK SYNDROME DUE TO NONINVASIVE PHARYNGITIS
    CHAPNICK, EK
    GRADON, JD
    LUTWICK, LI
    KIM, J
    LEVI, M
    KIM, MH
    SCHLIEVERT, PM
    [J]. CLINICAL INFECTIOUS DISEASES, 1992, 14 (05) : 1074 - 1077
  • [10] Genetic and phenotypic diversity among isolates of Streptococcus pyogenes from invasive infections
    Chaussee, MS
    Liu, JZ
    Stevens, DL
    Ferretti, JJ
    [J]. JOURNAL OF INFECTIOUS DISEASES, 1996, 173 (04) : 901 - 908