title: Outbreak of group A streptococcal bacteremia in Sweden: an epidemiologic and clinical study.
abstract: The nationwide incidence of group A streptococcal bacteremia in Sweden was 1.8 per 100,000 population in 1987. During the winter season 1988-1989, the reported cases rate doubled and then declined to the previous level. The peak was due to a type T1/M1 Streptococcus pyogenes strain associated with an increased case fatality rate (33% vs. 15% for other T types). The highest incidence rates were found in the age groups less than 12 months and greater than 70 years. Among a sample of 79 patients hospitalized in November or December 1988, a portal of entry, mainly cutaneous, was recognized in 89% of the patients and concomitant conditions in 67%. Among the clinical findings were signs of skin or soft tissue infection (41%), local or generalized pain (41%), vomiting or diarrhea (24%), cough (18%), and upper respiratory tract symptoms (12%). A fatal outcome was associated with high age, lower respiratory tract or unknown focus, leukopenia on admission, start of antibiotic therapy greater than 6 h after the patient's initial contact with a physician, and a rapid clinical course including multiple organ failure. Renewed awareness of the many facets of fulminant streptococcal infection represents one approach to minimize the case fatality rate.
authors.affiliation: Department of Infectious Diseases, Danderyd Hospital, Sweden.
authors.forename: A
authors.initials: A
authors.lastname: Strömberg
authors.forename: V
authors.initials: V
authors.lastname: Romanus
authors.forename: L G
authors.initials: LG
authors.lastname: Burman
mesh_terms: D004196:Disease Outbreaks; D006801:Humans; D012189:Retrospective Studies; D012621:Seasons; D018805:Sepsis / Q000453:epidemiology*; D013290:Streptococcal Infections / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D013297:Streptococcus pyogenes; D013548:Sweden / Q000453:epidemiology