Characterisation of bone and joint infections due to Group B Streptococcus serotype III sequence type 283

Abstract

In 2015, an epidemic of Group B Streptococcus (GBS) serotype III sequence type 283 (ST283) disease was reported in Singapore, associated with consumption of raw freshwater fish. In this study, we further characterise the characteristics of bone and joint infections associated with ST283 GBS in adults and the differences between ST283 and non-ST283 manifestations. A retrospective study of 54 inpatients with invasive GBS disease involving bones and/or joints from 2010 to 2015 was performed. Archived isolates were identified as GBS serotype III and ST283 positive using PCR methods. Clinical data were collected from a review of clinical charts. Twenty-three cases were ST283 and 31 were non-ST283. ST283 GBS patients were more likely to be of Chinese ethnicity, have lower Charlson comorbidity scores, and have fewer overall comorbidities, including diabetes mellitus with end-organ damage, peripheral vascular disease, and previous stroke, compared to non-ST283 GBS patients. ST283 patients had more oligoarthritis, with greater involvement of the knee, shoulder, and vertebrae, compared to monoarticular joint involvement in non-ST283 patients. Six patients had a unique combination of knee and shoulder joint involvement. All ST283 cases were mono-microbial, compared to a significant proportion of polymicrobial cultures in non-ST283 patients. Non-ST283 patients had a significantly longer length of stay and were more likely to undergo amputation or wound debridement. This study adds to growing evidence of a distinct clinical presentation associated with ST283 GBS, involving predominantly healthier patients without significant comorbidities, and with distinct clinical manifestations with regard to bone and joint disease.

Keywords: Food-borne disease; Group B Streptococcus; Oligoarthritis; Osteomyelitis; Septic arthritis; Streptococcus agalactiae.