Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jan 29;14(1):19.
doi: 10.1186/s13613-024-01249-7.

Clinical and molecular epidemiological features of critically ill patients with invasive group A Streptococcus infections: a Belgian multicenter case-series

Marijke Peetermans #  1   2 , Veerle Matheeussen #  3   4 , Cedric Moerman  5   6 , Fréderic De Rydt  5   7 , Sabine Thieren  8   9 , Emily Pollet  8 , Michael Casaer  10   11 , Benjamin De Backer  12 , Rudi De Paep  5 , Yves Debaveye  10   11 , Lars Desmet  13 , Stefanie Desmet  14 , Els I M Duval  5 , Vincent Fraipont  15 , Dieter Geysels  3 , Greet Hermans  8 , Frederik Lahaye  5 , Xavier Mathy  15 , Philippe Meersseman  8 , Cécile Meex  16 , Jozef Van Herck  5 , Stefanie van Kleef-van Koeveringe  3 , Nathalie Layios #  17   18 , Joost Wauters #  8   19 , Philippe G Jorens #  5   20
Affiliations

Clinical and molecular epidemiological features of critically ill patients with invasive group A Streptococcus infections: a Belgian multicenter case-series

Marijke Peetermans et al. Ann Intensive Care. .

Abstract

Background: Recent alerts have highlighted an increase in group A streptococcal (GAS) infections since 2022 in Europe and the United States. Streptococcus pyogenes can cause limited skin or mucosal disease, but can also present as severe invasive disease necessitating critical care. We performed a multicenter retrospective study of patients with GAS infections recently admitted to Belgian intensive care units (ICUs) since January 2022. We describe patient characteristics and investigate the molecular epidemiology of the S. pyogenes strains involved.

Results: Between January 2022 and May 2023, a total of 86 cases (56 adults, 30 children) with GAS disease were admitted to critical care in the university hospitals of Leuven, Antwerp and Liège. We noted a strikingly high incidence of severe community-acquired pneumonia (sCAP) (45% of adults, 77% of children) complicated with empyema in 45% and 83% of adult and pediatric cases, respectively. Two-thirds of patients with S. pyogenes pneumonia had viral co-infection, with influenza (13 adults, 5 children) predominating. Other disease presentations included necrotizing fasciitis (23% of adults), other severe skin/soft tissue infections (16% of adults, 13% of children) and ear/nose/throat infections (13% of adults, 13% of children). Cardiogenic shock was frequent (36% of adults, 20% of children). Fifty-six patients (65%) had toxic shock syndrome. Organ support requirements were high and included invasive mechanical ventilation (77% of adults, 50% of children), renal replacement therapy (29% of adults, 3% of children) and extracorporeal membrane oxygenation (20% of adults, 7% of children). Mortality was 21% in adults and 3% in children. Genomic analysis of S. pyogenes strains from 55 out of 86 patients showed a predominance of emm1 strains (73%), with a replacement of the M1global lineage by the toxigenic M1UK lineage (83% of emm1 strains were M1UK).

Conclusions: The recent rise of severe GAS infections (2022-23) is associated with introduction of the M1UK lineage in Belgium, but other factors may be at play-including intense circulation of respiratory viruses and potentially an immune debt after the COVID pandemic. Importantly, critical care physicians should include S. pyogenes as causative pathogen in the differential diagnosis of sCAP.

Keywords: Community-acquired pneumonia; Critical care; Empyema; Group A streptococci; Influenza; Invasive; Necrotizing fasciitis; Streptococcus pyogenes; Toxic shock syndrome; Viral coinfection.

PubMed Disclaimer

Conflict of interest statement

JW received investigator-initiated grants from Pfizer, Gilead and MSD and speakers’ and travel fees from Pfizer, Gilead and MSD, and declares participation in advisory boards of Pfizer and Gilead, all outside the scope of this study.

Figures

Fig. 1
Fig. 1
Maximum likelihood phylogenetic tree constructed from core SNPs of the 40 emm1 S. pyogenes isolates, with MGAS5005 as reference, differentiating between the M1global and M1UK lineage. Green: adult (n = 24), red: pediatric (n = 16) strains
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Brouwer S, Rivera-Hernandez T, Curren BF, Harbison-Price N, De Oliveira DMP, Jespersen MG, et al. Pathogenesis, epidemiology and control of Group A Streptococcus infection. Nat Rev Microbiol. 2023;21(7):431–447. doi: 10.1038/s41579-023-00865-7. - DOI - PMC - PubMed
    1. Schmitz M, Roux X, Huttner B, Pugin J. Streptococcal toxic shock syndrome in the intensive care unit. Ann Intensive Care. 2018;8(1):88. doi: 10.1186/s13613-018-0438-y. - DOI - PMC - PubMed
    1. Kiska DL, Thiede B, Caracciolo J, Jordan M, Johnson D, Kaplan EL, et al. Invasive group A streptococcal infections in North Carolina: epidemiology, clinical features, and genetic and serotype analysis of causative organisms. J Infect Dis. 1997;176(4):992–1000. doi: 10.1086/516540. - DOI - PubMed
    1. van der Putten BCL, Vlaminckx BJM, de Gier B, Freudenburg-de Graaf W, van Sorge NM. Group A Streptococcal meningitis with the M1UK variant in the Netherlands. JAMA. 2023;329(20):1791–1792. doi: 10.1001/jama.2023.5927. - DOI - PMC - PubMed
    1. de Gier B, Vlaminckx BJM, Woudt SHS, van Sorge NM, van Asten L. Associations between common respiratory viruses and invasive group A streptococcal infection: a time-series analysis. Influenza Other Respir Viruses. 2019;13(5):453–458. doi: 10.1111/irv.12658. - DOI - PMC - PubMed