Severe Streptococcus pyogenes infections, United Kingdom, 2003-2004

Abstract

As part of a Europe-wide initiative to explore current epidemiologic patterns of severe disease caused by Streptococcus pyogenes, the United Kingdom undertook enhanced population-based surveillance during 2003-2004. A total of 3,775 confirmed cases of severe S. pyogenes infection were identified over 2 years, 3.33/100,000 population, substantially more than previously estimated. Skin/soft tissue infections were the most common manifestation (42%), followed by respiratory tract infections (17%). Injection drug use was identified as a risk factor for 20% of case-patients. One in 5 infected case-patients died within 7 days of diagnosis; the highest mortality rate was for cases of necrotizing fasciitis (34%). Nonsteroidal antiinflammatory drugs, alcoholism, young age, and infection with emm/M3 types were independently associated with increased risk for streptococcal toxic shock syndrome. Understanding the pattern of these diseases and predictors of poor patient outcome will help with identification and assessment of the potential effect of targeted interventions.

Figure 1

Age- and sex-specific annual incidence of severe Streptococcus pyogenes infection in England, Wales, and Northern Ireland, 2003–2004. Error bars show 95% confidence intervals.

Figure 2

Seasonal trends in reports of severe Streptococcus pyogenes infection in the United Kingdom, 2003–2004. Moving average (6 wk) is the average count for the previous 6 weeks.