Ökande antal svårt sjuka av grupp A-streptokocker. Hög dödlighet vid invasiv infektion - tidig diagnos kan rädda liv
Sammanfattning
Increase in serious infections due to group A streptococci
Infections with Group A streptococci (GAS, Streptococcus pyogenes) are common, especially among small children. Mild pharyngitis, skin infections or asymptomatic carriage are most frequent. Due to toxins, other virulence factors, and host factors, these bacteria may cause rapidly developing, life-threatening conditions. Since the 1980s streptococcal toxic shock syndrome (STSS) and invasive GAS-infections seem to have become more common, though with varying incidence over the years. The number of reported cases in 2012 in Sweden was the highest since the disease became reportable in 2004, and the increase has continued in 2013. Severe manifestations are more frequently caused by specific GAS-types, such as type M1/emm1. Due to their severity and high mortality, these infections are included among diseases mandatory to report in Sweden. Reporting and microbiological typing is important in order to monitor epidemiology. Two severe cases of invasive GAS infections that occurred during 2012 are described, both requiring treatment with extracorporeal membrane oxygenation (ECMO). One patient had STSS and peripheral ischemia resulting in amputation of three limbs. Both patients had children attending the same daycare center. As a precaution, symptomatic children and staff at the daycare center were given penicillin V for 10 days and throat samples were taken and examined for GAS. All other children and staff, as well as their family members, were treated with penicillin for five days. After treatment, no further severe cases occurred. Eight GAS carriers were identified among the 28 examined persons with symptoms. The invasive isolate of one of the patients and all throat isolates were type T1/emm1.