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Group A Streptococcus (GAS) is a very important pathogenic organism, especially for children.Chinese experts′consensus statement on diagnosis, treatment, and prevention of Group A Streptococcus infection related diseases in children was developed in November 2022 by pediatric experts in the fields of respiration, infection, immunology, testing, cardiovascular, kidney, critical care and prevention in China, aiming to further standardize the prevention and treatment of diseases associated with GAS infections and to promote and maintain the health of children.Its main contents are now explained, including disease burden, prevention, diagnosis, antimicrobial resistance and therapy.
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Recently, there have been outbreaks of Group A Streptococcus (GAS) infection in foreign countries.The reasons are varied.With the relaxation of control for severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) infection, it is very likely that concurrent or secondary GAS infection peaks will occur at the same time as the number of Corona Virus Disease 2019(COVID-19) cases increases dramatically.Children are generally susceptible to GAS and are more vulnerable.In response to possible outbreaks, early identification of GAS infections and rational use of antibiotics are particularly important.
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At the end of 2022, the World Health Organization reported an increase in group A Streptococcus (GAS) infections, such as scarlet fever, in multiple countries. The outbreak primarily affected children under 10 years old, and the number of deaths was higher than anticipated, causing international concern. This paper reviews the current state of the GAS disease outbreak, its causes, and response measures. The authors aim to draw attention from clinical workers in China and increase their awareness and vigilance regarding this epidemic. Healthcare workers should be aware of the potential epidemiological changes in infectious diseases that may arise after the optimization of control measures for coronavirus disease 2019 to ensure children's health.
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Child , Humans , Streptococcus pyogenes , COVID-19/epidemiology , Streptococcal Infections/epidemiology , Scarlet Fever/epidemiology , Epidemics , Disease OutbreaksABSTRACT
Group A Streptococcus (GAS) is one of the most important pathogens leading to children deaths all over the world.Bacterial typing is the commonest approach to analyzing the epidemiological characteristics of pathogenic microorganisms.The emm typing is frequently adopted to study GAS.The emm cluster typing is a recently proposed typing method based on the amino acid sequence homology of M proteins and the ability to bind to the host serum protein.This typing system has been extensively used for epidemiological investigation, strain selection and vaccine deve-lopment in foreign countries.However, it has not been applied in China yet. emm typing is based on a small variable region of emm genes, while the emm cluster typing system defines GAS types according to nearly intact sequences of emm genes.Besides, the emm cluster grouping system is acquired directly by emm typing comparison, so it is simple and feasible.Furthermore, the emm cluster typing can provide more information regarding the functional and structural properties of M proteins in different emm types of GAS.In this review, the methods, principles and applications of the emm cluster typing system in GAS research were summarized, in order to promote its application in China.
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Objective:To analyze the clinical characteristics of Group A Streptococcal(GAS) toxic shock syndrome (STSS) in children. Methods:The clinical data of 10 STSS children hospitalized in Shenzhen Children′s Hospital from January 2015 to March 2022 were downloaded from the electronic medical record system.The clinical manifestations were analyzed and treatment experience was summarized respectively.Results:There were 5 males and 5 females, with an average age of (5.29±2.87) years.All the patients were healthy in the past.The diagnoses were confirmed by blood culture in 2 cases, pus culture in 5 cases, and blood metagenomics next generation sequencing in 3 cases.The rapid detection of GAS antigen was positive in 7 cases.All cases had fever, and 9 cases of them developed fever after viral infection, including pneumonia in 7 cases, skin and soft tissue infections in 6 cases, necrotizing fasciitis in 3 cases, and purulent meningitis in 1 case.All cases also presented with shock.Six cases had liver function injury, and 4 cases suffered from acute kindey injury.Four cases had infection-related encephalopathy, and 7 cases were afflicted with disseminated intravascular coagulation.Two cases had respiratory failure, and 2 cases had rhabdomyolysis.There were 3 cases with a decreased white blood cell (WBC) count and 7 cases with an increased WBC count on admission.Seven cases were found to have thrombocytopenia, but their platelet levels were all elevated after recovery.C-reactive protein and procalcitonin and the proportion of neutrophils were markedly increased in all cases.All cases suffered from hypoalbuminemia, hyponatremia and hypocalcemia.All the 10 positive strains were sensitive to Penicillin, Ceftriaxone/Cefotaxime and Vancomycin.Eight cases were treated with combined antibiotics after admission.Eight patients received intravenous immunoglobulin.All cases were cured and discharged.Conclusions:The STSS progresses rapidly in children, so pediatricians should pay great attention to the disease.Early identification, diagnosis of infection sources, infusion of antibiotics and surgical treatment are the keys to disease management.
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Objective:To identify the epidemic types of Group A Streptococcus (GAS)causing scarlet fever, to compare the gene structure and variability of GAS with different emm types, and to elucidate the epidemiological pattern of scarlet fever pathogens in Shenzhen. Methods:Pharyngeal swab samples were collected and analyzed retrospectively from children diagnosed with scarlet fever in Shenzhen Children′s Hospital from January 1, 2016 to May 31, 2018.The GAS strains were preserved for emm genotyping analysis.The strains of representative emm types were selected for whole-genome sequencing.The genomic polymorphism of GAS strains was described by comparative genomic analysis.Moreover, a phylogenetic tree was constructed based on the whole genome core-gene single nucleotide polymorphisms(SNPs) to clarify the evolutionary relationship between strains.Data between groups were compared by Rank sum test. Results:Among 176 GAS isolates that caused scarlet fever in children, 8 emm types were detected.The most common genotype was emm12.0 and its subtype(108/176 strains, 61.4%), followed by emm1.0 and its subtype(53/176 strains, 30.1%). These two genotypes accounted for 91.5% of all isolates collected.Comparative genome analysis was made taking GCA-900984775 as a reference sequence, and the results showed that the genomes of GAS strains had high levels of SNP and insertion or deletion (InDel) polymorphisms.There were more SNPs in emm12.0 strains[183(163, 213)] than those in emm1.0 strains[63 (54, 75)], and the difference was statistically significant ( P<0.05). As for InDel, more insertions and deletions [4(3, 6), 8(6, 10)] were observed in emm12.0 strains than those [1(0, 2), 5(3, 7)] in emm1.0 strains.According to the phylogenetic tree built by taking MGAS5005 as the reference sequence based on the whole genome core-gene SNPs, 18 strains and reference strains formed two clades. Conclusions:The emm12.0 and emm1.0 types are the most common GAS strains leading to scarlet fever in children.There are differences in the genome composition of different GAS strains.The emm12.0 strains have higher genetic diversity.
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Objective:To analyze the genetic characteristics of Group A Streptococcus (GAS) isolated from the pharynx of children with scarlet fever-like erythema. Methods:Pharyngeal GAS isolates were collected retrospectively from children with scarlet fever-like erythema admitted in the Department of Dermatology, Beijing Children′s Hospital, Capital Medical University from June 2019 to February 2020.PCR and sequencing were used to detect emm genotyping and superantigen genes( speA, speB, speC, speF, speG, speH, speI, speJ, speK, speL, speM, ssa and smeZ) of the isolates.Data were compared by the chi-square test or Fisher′ s exact test between groups. Results:A total of 147 GAS strains were collected.The main emm genotypes were emm1.0 in 76 strains (51.70%) and emm12.0 in 60 strains (40.82%). Other 7 emm genotypes were all found in less than 5 strains.The detection rate of speF, smeZ, speG, speC, speB and ssa were as high as 100.00%(147/147 strains), 100.00%(147/147 strains), 99.32%(146/147 strains), 95.24%(140/147 strains), 94.56%(139/147 strains) and 92.52%(136/147 strains), respectively. speA, speJ, speI, speH and speM had a low detection rate of 51.70%(76/147 strains), 49.66%(73/147 strains), 32.65%(48/147 strains), 23.81%(35/147 strains) and 4.08%(6/147 strains), respectively.No speK and speL were detected.The frequencies of speA and speJ in emm1.0 strains (65/76 strains, 85.53% and 64/76 strains, 84.21%) were significantly higher than those in emm12.0 strains (4/60 strains, 6.67% and 6/60 strains, 10.00%). However, the frequencies of speH and speI in emm1.0 strains (7/76 strains, 9.21% and 2/76 strains, 2.63%) were significantly lower than those in emm12.0 strains (28/60 strains, 46.67% and 45/60 strains, 75.00%) (all P<0.001). Conclusions:At present, emm1.0 and emm12.0 are the main GAS strains isolated from the throat of children with scarlet fever-like erythema in Beijing, and emm1.0 is more common.There is a correlation between emm genotyping and the superantigen gene profile.Type 1 superantigen gene profile is significantly more frequently detected in emm1.0 strains than in emm12.0 strains.Type 2, 3 and 4 superantigen gene profiles are significantly more frequently detected in emm12.0 strains than in emm1.0 strains.
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Objective:To clarify the M protein ( emm gene) types and drug susceptibility characteristic variations of Group A Streptococcus (GAS) in children in Beijing. Methods:The GAS strains isolated from throat swab samples of children diagnosed with scarlet fever and pharyngeal infection in scarlet fever etiology surveillance sentinel hospitals in 16 districts of Beijing in 2018, 2019 and 2021 were analyzed retrospectively.PCR amplification and sequencing were used for emm genotyping, and the minimum inhibitory concentrations (MIC) of 10 antibiotics were determined by the broth microdilution method.The data were analyzed using χ2 test and Fisher′ s exact method between groups. Results:A total of 557 GAS strains were collected, and 11 emm genotypes ( emm1, emm3, emm4, emm6, emm11, emm12, emm22, emm75, emm89, emm128, and emm212) were detected.Of 557 strains, 238 trains were of emm1 type (42.73%), 271 strains were of emm12 type (48.65%) and 48 strains were of other emm types (8.62%). The detection rates of emm1, emm12 and other emm type genes in 2018, 2019, and 2021 were [37.50% (105/280 strains), 57.14% (160/280 strains), 5.36% (15/280 strains)], [49.05% (129/263 strains), 39.54% (104/263 strains), 11.41% (30/263 strains)], and [28.57% (4/14 strains), 50.00% (7/14 strains), 21.43% (3/14 strains)], respectively.In children infected with emm12 in 2018 and 2019, there were more children under 6 years old than children over 6 years old (62.50% vs.46.88%, 46.36% vs.30.36%) (χ 2=7.182, 6.973; all P<0.05). Drug susceptibility testing results suggested that 225 randomly selected GAS strains were all 100.00% sensitive to 7 antibiotics including Penicillin, Levofloxacin, Meropenem, Linezolid, Cefotaxime, Cefepime and Vancomycin.The rates of resistance to Erythromycin, Tetracycline and Clindamycin were [88.57% (93/105 strains), 87.62% (92/105 strains), 86.67% (91/105 strains)], and [94.34% (100/106 strains), 94.34% (100/106 strains), 87.74% (93/106 strains)] in 2018 and 2019, respectively.The test strains were 100.00% (14/14 strains) resistant to the above 3 antibiotics in 2021.MIC 50 and MIC 90 values of Penicillin in 2018, 2019, and 2021 were (0.03 mg/L, 0.03 mg/L), (0.03 mg/L, 0.06 mg/L), and (0.06 mg/L, 0.06 mg/L), respectively.Among 225 GAS strains, 207 strains had drug resistance and were resistant to more than one drug.Specifically, 94.69% (196/207 strains) were resistant to Erythromycin, Tetracycline and Clindamycin.About 4.35% (9/207 strains) were resistant to both Erythromycin and Clindamycin.A total of 0.97% (2/207 strains) were resistant to Erythromycin and Tetracycline. Conclusions:The emm genotypes of GAS in children in Beijing are diverse in 2018, 2019 and 2021.The dominant genotypes are emm12 and emm1, and emm12 is the main epidemiological type.GAS strains maintain highly resistant to Erythromycin, Clindamycin and Tetracycline, and sensitive to Penicillin and other antibiotics.However, MIC 50 and MIC 90 of Penicillin shows an ascending trend.
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As a pathogen of public health significance, group A Streptococcus (GAS) infects 18.1 million people and leads to 500 000 deaths all over the world every year.GAS is often transmitted through respiratory droplets and contact with damaged skin.Children, the elderly and immunocompromised people are highly susceptible to GAS infection.Schools, kindergartens, hospitals, nursing homes and other densely populated areas are high-risk areas for GAS transmission.Prevention and control measures should highlight the improvement of living conditions and hand hygiene.Adherence to infection prevention and control measures should be emphasized in high-risk environments.In this paper, the risk factors, prevention and control strategies of GAS infection and transmission were summarized, so as to provide basis for the prevention and control of GAS.
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Streptococcal toxic shock syndrome (STSS) is a Group A Streptococcus (GAS) induced invasive infectious disease, which is characterized by abrupt onset and rapid progression with a high mortality rate.With the wide application of antimicrobial agents, the incidence of GAS infections has been substantially reduced.Nevertheless, STSS usually causes shock and multiple organ failure at the early stage of its clinical process, and the clinical symptoms are non-specific.Therefore, early identification, timely anti-infection and symptomatic treatment are particularly critical.Clinicians should pay high attention to the disease.
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Acute necrotizing fasciitis is a rare and life-threatening soft-tissue infection characterized by the rapid spread of inflammation and subsequent necrosis of the fascial planes and surrounding tissue.Its fatality rate in children reaches up to 10%.Group A Streptococcus is the common cause of acute necrotizing fasciitis.Patients with this disease should be treated promptly with antibiotics and surgical debridement.
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Scarlet fever is a respiratory disease caused by Group A Streptococcus (GAS). It commonly attacks school children and has no available vaccine currently.The human history, especially European Industrial Revolution and Victorian Era, has witnessed large scale scarlet fever epidemics.Before antibiotics were invented, scarlet fever was once a highly transmissible disease with high mortality about 30%-50%.With the wide use of antibiotics after World War Ⅱ, the incidence and mortality of scarlet fever decrease significantly.Invasive streptococcal infections resurge in Europe and America in 1980s.In the past ten years, the incidence of scarlet fever kept increasing in several countries around the world.In this article, the latest research progress of scarlet fever epidemiology and pathogenesis was reviewed.Meanwhile, potential mechanisms and risk factors for the recently increasing incidence of scarlet fever in various regions were discussed.
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Group A Streptococcus (GAS), also known as Streptococcus pyogenes, is one of the key pathogenic bacteria leading to bacterial infection in children.GAS infection can result in both non-invasive and invasive infections.GAS plays a crucial role in contributing to childhood respiratory tract infections, including pharyngitis, tonsillitis and pneumonia.In order to improve clinical understanding of GAS, the relationship between GAS and respiratory tract infections were introduced from the aspects of epidemiology, pathogenesis, clinical characteristics, diagnosis and treatment.
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Group A Streptococcus (GAS) is a beta-hemolytic Streptococcus, which is often referred to as Streptococcus pyogenes in traditional clinical practice.It is the most important pathogenic bacterium in the Streptococcus genus.GAS infection and its sequelae have a huge impact on the health of children and the youth.Therefore, it has always been a serious problem that adversely affects public health and the national economy.The purpose of this article is to advocate early, rapid, and accurate diagnosis of GAS infection in order to reduce the severity of the disease, guide the rational use of antibiotics, and achieve the best cost-effectiveness effect.
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Group A Streptococcus (GAS) is a very important pathogen, especially for children.On a global scale, GAS is an important cause of morbidity and mortality.But the burden of disease caused by GAS is still unknown in China and also has not obtained enough attention.For this purpose, the expert consensus is comprehensively described in diagnosis, treatment and prevention of GAS diseases in children, covering related aspects of pneumology, infectiology, immunology, microbiology, cardiology, nephrology, critical care medicine and preventive medicine.Accordingly, the consensus document was intended to improve management strategies of GAS disease in Chinese children.
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Group A Streptococcus(GAS) is a very important pathogen, especially for children.GAS may cause more kinds of diseases than any other microorganism and involve many disciplines.Since penicillin was discovered and widely used in the 1940s, bacterial infectious diseases have been conquered, and the incidence rate has decreased.However, the occurrence of antibiotics resistance is becoming more and more serious, and some bacterial infectious diseases have a rising trend.In recent years, GAS infection and disease have also been reported in a small range.There are not many Chinese people who pay attention to GAS, especially those who study GAS.They do not have enough understanding of GAS, which leads to some misunderstandings.There are still many questions about GAS that no one can explain so far.Therefore, we call for attention to GAS and GAS diseases.
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Rheumatic heart disease (RHD) is an auto immune sequelae of rheumatic fever (RF) caused by Group A Streptococcal (GAS) pharyngitis, rather than the direct bacterial infection of the heart, which leads to chronic heart valve damage. Although antibiotics like penicillin are effective against GAS infection, improper medical care such as poor patient compliance, overcrowding, poverty, and repeated exposure to GAS, leads to acute rheumatic fever and RHD. Thus, effort to design a vaccine based on emm gene identification of GAS, M-protein going on for more than 40 years, is unlikely to succeed. M-protein is strain specific. Infection with one strain does not provide immunity from infection with another strain. Based on the emm gene identification, of 250 or more identified strains of GAS, the distribution is heterogenous and keeps changing. The M-protein gene sequence of the organism tends to mutate. A vaccine prepared from available strains may not be effective against a strain following mutation.
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BACKGROUND: The SD Bioline Strep A Ultra (SD, Yongin, Korea) is a recently developed rapid antigen detection test (RADT) for diagnosing bacterial pharyngitis caused by Group A Streptococcus, We evaluated the performance of SD Bioline Strep A Ultra, using the number of colony forming units and color intensity. METHODS: Three throat swabs each were taken from 343 children with pharyngitis who visited pediatric clinics. We evaluated the performance of SD Bioline Strep A Ultra and compared its positive rate with the number of colony forming units, using the Fisher exact test. RESULTS: The sensitivity, specificity, positive predictive value, and negative predictive value (95% confidence interval) were 97.4% (94.0–99.1%), 90.8% (85.0–94.9%), 93.0% (88.5–96.1%), and 96.5% (92.0–98.9%), respectively. Positive rate significantly differed by number of colony forming units (P=0.021). ROC plot for color intensity showed 0.938 of AUC (area under curve). CONCLUSIONS: SD Bioline Strep A Ultra showed excellent performance, and its positive rate differed by the number of colony counts. This RADT could be used as a sensitive and semi-quantitative method detecting bacterial pharyngitis.
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Child , Humans , Area Under Curve , Methods , Pharyngitis , Pharynx , Sensitivity and Specificity , Stem Cells , StreptococcusABSTRACT
Objective To analyze the characteristics of antibiotic resistance in group A Streptococ-cus ( GAS) strains isolated from children with scarlet fever in Tianjin in order to provide reference for clinical drug administration. -ethods GAS strains were collected from 2011 to 2016. A total of 276 isolates were analyzed by antibiotic susceptibility test and emm typing. Results All of the isolates were susceptible to penicillin, cefazolin and vancomycin, while 98. 2％ were susceptible to both chloramphenicol and levofloxa-cin. The resistance rates to azithromycin, erythromycin, clarithromycin, clindamycin and tetracycline were 97. 8％, 97. 1％, 94. 2％, 94. 2％ and 79. 3％. The concomitant resistance to erythromycin, azithromycin, clarithromycin, clindamycin and tetracycline was 73. 2％. The resistance rates of GAS strains isolated from different years to tetracycline, clindamycin, clarithromycin, erythromycin and azithromycin were significantly different. A statistically significant difference was found between the percentages of emm12 and emm1 strains resistant to tetracycline (84. 0％ vs 59. 5％, χ2=13. 820, P=0. 000). Conclusions The isolated GAS strains are sensitive toβ-lactams and highly resistant to macrolide antibiotics, clindamycin and tetracycline. Penicillin remains the preferred treatment for GAS infection and cephalosporins may be used as a substitute if the patient is allergic to penicillin.
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Background: Group A streptococcus (GAS) causes a wide variety of diseases ranging from mild skin and soft-tissue infections to severe, life-threatening conditions. A fluctuating trend has been observed in the antibiotic resistance pattern from different parts of the world. The present study was undertaken to determine the prevalence of antibiotic resistance among GAS isolates and the underlying genetic mechanisms. Materials and Methods: Two hundred and six GAS isolates were characterised by antimicrobial susceptibility pattern, macrolide resistance phenotype (double-disc test) and resistance determinants by multiplex polymerase chain reaction. Results: All the isolates were susceptible to penicillin, vancomycin and linezolid. Erythromycin resistance was found in 53% of isolates with inducible macrolide, lincosamide and streptogramin B the predominant phenotype (63%) with ermB the major genetic determinant. Clindamycin resistance was observed in 33% of isolates with all being inducible resistant. Tetracycline resistance was found in 58% of isolates with tetM as the major genetic determinant (97%). Erythromycin and tetracycline co-resistance was found in 39% of tested GAS isolates. Conclusion: The erythromycin and tetracycline resistance in GAS continues to exist at high levels and may be attributed to the over-prescription and use of these antibiotics. Our findings indicate that the use of these antibiotics especially macrolides as empiric therapy in penicillin-allergic patients may not be appropriate.