Search Results (25)

An increase in invasive group A streptococcal (iGAS) infections among children under 15 years of age was reported in several countries between late 2022 and early 2023. This retrospective study aims to describe the epidemiology and clinical features of iGAS infections in children in Cyprus during the same period. Medical records of patients under 16 years old admitted with iGAS infection to the Archbishop Makarios Hospital, the only tertiary paediatric referral centre in Cyprus, between 1 January 2021 and 30 June 2024, were reviewed. Twenty-two cases were identified, of which twenty were classified as confirmed and two as probable. Half of the cases occurred in children aged 0–4 years, and 59% were recorded between December 2022 and April 2023. Scarlet fever was diagnosed in six children, five of whom developed pneumonia and empyema. Streptococcal toxic shock syndrome (STSS) was observed in five patients, resulting in two deaths and one case requiring prolonged extracorporeal membrane oxygenation (ECMO). The overall case fatality rate was 9.1%. Emm 1, belonging to the M1UK clone, was the predominant strain (66.6%). The findings underscore the severity of iGAS infections, particularly in younger children, and highlight the importance of timely diagnosis, appropriate management and continued epidemiological surveillance. Full article

Group A Streptococcus (GAS) imposes a significant global health burden across all age groups, annually causing over 600 million cases of pharyngitis and more than 18 million severe invasive infections or sequelae. The resurgence of scarlet fever globally and streptococcal toxic shock syndrome (STSS) outbreaks in Japan have brought GAS infections back into the spotlight as a pressing global health concern. Unfortunately, no licensed vaccine against GAS is yet available for clinical use. Our comprehensive review examines the developmental history of GAS vaccines, outlining the research trajectory from early inactivated vaccines to contemporary multivalent, conjugate, multi-antigen, and mRNA-based vaccine platforms. It systematically analyzes clinical trial outcomes of GAS vaccines, highlighting recent advances in both M protein-based and non-M protein vaccine candidates while summarizing promising target antigens. The review concludes with critical strategies to accelerate vaccine commercialization, including enhanced investment in research and development, expanded collaborations, leveraging advanced vaccine technologies, streamlined clinical trials, and strengthened public health advocacy. This review critically evaluates the current evidence and future prospects in GAS vaccine development, emphasizing innovative strategies and engaging broader stakeholders to accelerate GAS vaccine development. Full article

Background: Streptococcal toxic shock syndrome (STSS) is a serious and potentially fatal complication of invasive Streptococcus pyogenes (Group A Streptococcus, GAS) infection, often stemming from severe soft tissue infections. While uncommon, tonsillitis can also lead to STSS, with lethality rates reported as high as 70%. Methods: We present three cases of patients diagnosed with tonsillitis who developed STSS. Point-of-care testing for GAS antigens was utilized to facilitate rapid diagnosis. Results: In all three cases, the characteristic clinical presentations, including scarlatiniform rash, strawberry tongue, and signs of shock with multi-organ dysfunction, were observed. Microbiological evidence confirmed ongoing GAS infections, and point-of-care testing for GAS antigens assisted in the diagnosis of tonsillitis in conjunction with STSS, enabling timely treatment interventions. Conclusions: Rapid diagnosis is crucial for the optimal management of STSS. The point-of-care testing for GAS may be useful for diagnosing STSS associated with tonsillitis. Full article

Background: Acute pharyngitis is one of the most prevalent disorders seen in general practitioners’ consultations. Most cases of acute pharyngitis in adults are caused by respiratory viruses and are self-limited. However, clinical manifestations of viral pharyngitis can overlap with bacterial pharyngitis, mainly caused by group A Streptococcus (GAS). A rapid antigen test for GAS can help diagnose streptococcal pharyngitis, but misdiagnosing S. pyogenes infection in a patient with a viral condition can lead to inappropriate antibiotic use. Some patients with a sore throat due to a virus or other causes will test positive for GAS because of carriage. The aim of our study was to analyze rapid strep test results in healthy adults. Methods: A cohort study was conducted in an outpatient clinic in Wroclaw. We used the rapid strep test BIOSYNEX STREP A. Results: A total of 350 healthy volunteers (≥18 years old) were enrolled in this study. The presence of Streptococcus pyogenes, based on a rapid strep test, was detected in 17 adults (4.9%). The strep test positivity rate was higher in younger adults. Conclusions: In healthy individuals in Poland, the prevalence of pharyngeal carriage of GAS is 4.9%. This finding emphasizes that the rapid antigen detection test should only be used in cases of suspected bacterial pharyngitis to avoid inappropriate antibiotic use. Full article

Acute pharyngotonsillitis is a common reason to visit primary care providers. Group A Streptococcal (GAS) pharyngitis is the most common bacterial infection which needs antibiotic treatment. GAS accounts for only 10–15% of adult acute pharyngitis cases. The overuse of antibiotics for viral pharyngotonsillitis is common and may lead to inappropriate antimicrobial stewardship and the emergence of bacterial resistance. However, the etiology of acute pharyngotonsillitis for hospitalized adult patients is rarely studied. So, we reported the 10-year surveillance data of hospitalized adult patients with acute pharyngotonsillitis in a regional hospital in Taiwan. Every consecutive adult patient admitted with acute pharyngotonsillitis in 2011–2021 was recruited for a complete etiology study. The etiology of acute pharyngotonsillitis was identified in 117 patients. Overall, 42 herpes simplex virus cases, 26 adenovirus cases, 16 acute human immunodeficiency virus cases, 12 influenza cases, three parainfluenza cases, six Epstein–Barr virus cases, one cytomegalovirus case, four enterovirus cases, one varicella-zoster virus case, four Mycoplasma pneumoniae cases, one Chlamydophila pneumoniae case, and only one GAS case were identified. The average of the points for the Modified Centor Criteria was 1.38 (55% of patients with 0–1 points and 45% with 2–3 points). However, 88.9%of patients received antibiotics at the emergency department, and 76.9%also received antibiotics while hospitalized. Only a few patients required antibiotic treatment, while the majority of patients with viral illness needed only symptomatic treatment. However, distinguishing viral etiology from GAS pharyngitis is challenging even in the presence of tonsil exudates, high C-reactive protein, and leukocytosis. A diagnostic algorithm and the application of the Modified Centor Criteria should be considered for hospitalized adults with acute pharyngotonsillitis to improve antimicrobial stewardship. Full article

Since the beginning of December 2022, an unusually high number of cases and deaths of Group A Streptococcus (GAS) infections has been reported in many European countries. GAS infection frequently causes mild diseases such as pharyngitis, tonsillitis, impetigo, cellulitis, and scarlet fever. However, in rare instances, GAS infection can lead to invasive, life-threatening conditions like necrotizing fasciitis and toxic shock syndrome, which are associated with high mortality. The aim of the study was to present the clinical course of invasive Streptococcus pyogenes infections and to highlight the increase in the incidence of severe infections of this etiology, similar to trends observed in other European countries. The study included 11 patients with severe, invasive infections caused by S. pyogenes accompanied by sepsis or septic shock, treated at the 4th Clinical Military Hospital in Wroclaw between December 2022 and May 2023. Among 11 patients, 6 had streptococcal skin and soft tissue infections, 3 had pneumonia caused by S. pyogenes, 1 had streptococcal otitis, and 1 had a knee joint infection. Nine developed septic shock, and three died from fulminant streptococcal toxic shock syndrome (STSS). Physicians should be aware of the increased prevalence of invasive GAS (iGAS) infections; timely diagnosis and effective treatment are crucial to reducing the risk of severe complications, including death. Full article

Background: The diagnosis of streptococcal throat infection is an area where current practice results in significant over-diagnosis of bacterial infection, with the resulting implications for antimicrobial use and resistance. The use of molecular point of care testing (POCT) has previously been shown to alter antibiotic prescribing decisions when compared to Centor scoring. This paper explores the impact of the addition of POCT to clinical assessment using the McIsaac and FeverPAIN scoring systems. Methods: Retrospective analysis of the clinical records of 144 patients who had previously received point of care testing as part of a trial of POCT as an adjunct to usual care was undertaken. The McIsaac and FeverPAIN scores were calculated and then compared with the POCT result originally obtained. The records were also reviewed to identify further consultations within 10 days of being tested. Results: Sufficient clinical data were available to calculate the FeverPAIN and McIsaac scores in 81% of patients and outcome data were available for 96.5% of patients. For patients with a FeverPAIN score of 4 or 5, 50–67% of patients had a positive POCT result, while for patients with a McIsaac score of 4 or 5, 50–68% had a positive POCT result. Moreover, 16.7% of patients who tested negative, and 16.3% of patients who tested positive, had a further consultation within 10 days of being assessed. Conclusions: Although relatively few patients in this study had maximum scores on the FeverPAIN and McIsaac scoring, the addition of POCT was shown to alter antibiotic prescribing decisions in a significant number of patients, supporting the use of Abbott ID NOW point of care testing to reduce antibiotic prescribing. Larger studies are required to confirm these results and explore the health economic aspects and potential impacts on health inequalities. Full article

Streptococcus pyogenes (Group A Streptococcus, GAS) is a human-restricted pathogen that causes a wide range of diseases from pharyngitis and scarlet fever to more severe, invasive infections such as necrotising fasciitis and streptococcal toxic shock syndrome. There has been a global increase in both scarlet fever and invasive infections during the COVID-19 post-pandemic period. The aim of this study was the molecular characterisation of 17 invasive and non-invasive clinical non-emm1 GAS isolates from an Australian tertiary hospital collected between 2021 and 2022. Whole genome sequencing revealed a total of nine different GAS emm types with the most prevalent being emm22, emm12 and emm3 (each 3/17, 18%). Most isolates (14/17, 82%) carried at least one superantigen gene associated with contemporary scarlet fever outbreaks, and the carriage of these toxin genes was non-emm type specific. Several mutations within key regulatory genes were identified across the different GAS isolates, which may be linked to an increased expression of several virulence factors. This study from a single Australian centre provides a snapshot of non-emm1 GAS clinical isolates that are multiclonal and linked with distinct epidemiological markers commonly observed in high-income settings. These findings highlight the need for continual surveillance to monitor genetic markers that may drive future outbreaks. Full article

A Europe-wide outbreak of invasive pediatric group A streptococcal infections (iGAS) began in fall 2022. Here, we report the evolution of GAS hospitalizations in children and adolescents during the second outbreak year in 2023–2024 at a tertiary center in Switzerland. Using prospective monitoring of all in-patient GAS cases below 16 years of age, including those with iGAS, we compared case frequencies and clinical characteristics in three time periods (2013–2020; 2022–2023; 2023–2024). Annual GAS hospitalizations increased from a median of 25 cases (range 11–28) in 2013–2020 to 89 and 63 cases, respectively, in 2022–2023 and 2023–2024. iGAS cases evolved similarly (2013–2020, 4 cases (3–8); 2022–2023, 32 cases; 2023–2024, 21 cases). The decline in cases from 2022–2023 to 2023–2024 included all types of GAS organ involvement, except suppurative infections in the head area, which remained largely unchanged (48 vs. 45 cases). Pleural empyema declined from 13 to 7 cases, possibly explained by a poor overlap of the GAS and influenza curves, respectively, in 2023–2024 compared to 2022–2023. These data document the prolongation of the GAS outbreak into its second winter season in 2023–2024. Full article

Since October 2022, alerts have spread from several countries about the increase in invasive group A streptococcal (iGAS) and scarlet fever cases affecting young children. We aim to analyze the epidemiology of GAS infections in the last 12 years in our hospital and identify the clinical features of invasive cases observed in 2023. We conducted a retrospective study enrolling children and adolescents hospitalized at our pediatric clinic from January to December 2023 for a definitive diagnosis of iGAS infection. Clinical, laboratory, and imaging data were collected and analyzed. Comparing 2016 and 2023, we observed a similar number of GAS infections (65 vs. 60 cases). Five children with iGAS infection were hospitalized between March and April 2023. The median age was five years. At admission, all patients showed tachycardia disproportionate to their body temperature. Vomiting was a recurrent symptom (80%). Laboratory tests mostly showed lymphopenia, hyponatremia, and high inflammatory markers. The number of pediatric iGAS cases significantly increased in 2023. Clinical (pre-school-aged children with high fever, unexplained tachycardia, and vomiting) and laboratory parameters (high procalcitonin levels, hyponatremia, and lymphopenia) could help identify and suspect a potential iGAS infection. Full article

Group A Streptococcus (GAS) presents a significant global health burden due to its diverse clinical manifestations ranging from mild infections to life-threatening invasive diseases. While historically stable, the incidence of GAS infections declined during the COVID-19 pandemic but resurged following the relaxation of preventive measures. Despite general responsiveness to β-lactam antibiotics, there remains an urgent need for a GAS vaccine due to its substantial global disease burden, particularly in low-resource settings. Vaccine development faces numerous challenges, including the extensive strain diversity, the lack of suitable animal models for testing, potential autoimmune complications, and the need for global distribution, while addressing socioeconomic disparities in vaccine access. Several vaccine candidates are in various stages of development, offering hope for effective prevention strategies in the future. Full article

Background. Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) syndrome is a rare pediatric disorder consisting of a sudden onset of obsessive–compulsive disorder (OCD) and/or tics after a group A Streptococcus (GAS) infection. Methods. In the period between 2013 and 2023, 61 children presented to our Pediatric Rheumatology unit with a suspicion of PANDAS syndrome. Among these, a retrospective analysis was conducted, and 19 fulfilled the current classification criteria and were included in this study. Results. The male-to-female ratio was 14:5, the median age at onset was 7.0 (2.0–9.5) years, and the median age at diagnosis was 8.0 (3.0–10.4) years. The median follow-up period was 16.0 (6.0–72.0) months. Family and personal history were relevant in 7/19 and 6/19 patients. Tics were present in all patients. Details for motor tics were retrospectively available in 18/19 patients, with the eyes (11/18) and neck/head (10/18) being most often involved. Vocal tics were documented in 8/19, behavioral changes in 10/19, and OCD in 2/19. Regarding the therapeutic response, all patients responded to amoxicillin, 12/13 to benzathine benzylpenicillin, and 7/9 to azithromycin. Conclusions. Our findings partially overlap with previous reports. Larger prospective studies are needed to improve treatment strategies and classification criteria. Full article

Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) syndrome is one of the most controversial diseases in pediatric rheumatology. Despite first being described more than 25 years ago as the sudden and rapid onset of obsessive–compulsive disorder (OCD) and/or tic disorder symptoms as complications of a Group A beta-hemolytic Streptococcus (GAS) infection, precise epidemiological data are still lacking, and there are no strong recommendations for its treatment. Recent advances in the comprehension of PANDAS pathophysiology are largely attributable to animal model studies and the understanding of the roles of Ca++/calmodulin-dependent protein kinase (CaM kinase) II, disrupted dopamine release in the basal ganglia, and striatal cholinergic interneurons. The diagnosis of PANDAS should be made after an exclusion process and should include prepubescent children with a sudden onset of OCD and/or a tic disorder, with a relapsing/remitting disease course, a clear temporal association between GAS infection and onset or exacerbation of symptoms, and the association with other neurological abnormalities such as motoric hyperactivity and choreiform movements. Antibiotic medications are the primary therapeutic modality. Nonetheless, there is a paucity of randomized studies and validated data, resulting in a scarcity of solid recommendations. Full article

Streptococcus pyogenes (group A Streptococcus; GAS), a Gram-positive coccal bacterium, poses a significant global disease burden, especially in low- and middle-income countries. Its manifestations can range from pharyngitis and skin infection to severe and aggressive diseases, such as necrotizing fasciitis and streptococcal toxic shock syndrome. At present, although GAS is still sensitive to penicillin, there are cases of treatment failure for GAS pharyngitis, and antibiotic therapy does not universally prevent subsequent disease. In addition to strengthening global molecular epidemiological surveillance and monitoring of antibiotic resistance, developing a safe and effective licensed vaccine against GAS would be the most effective way to broadly address GAS-related diseases. Over the past decades, the development of GAS vaccines has been stalled, mainly because of the wide genetic heterogeneity of GAS and the diverse autoimmune responses to GAS. With outbreaks of scarlet fever in various countries in recent years, accelerating the development of a safe and effective vaccine remains a high priority. When developing a GAS vaccine, many factors need to be considered, including the selection of antigen epitopes, avoidance of self-response, and vaccine coverage. Given the challenges in GAS vaccine development, this review describes the important virulence factors that induce disease by GAS infection and how this has influenced the progression of vaccine development efforts, focusing on several candidate vaccines that are further along in development. Full article