title: Invasive group A streptococcal infections in North Carolina: epidemiology, clinical features, and genetic and serotype analysis of causative organisms.
abstract: During 1994 and 1995, an increase in the number and severity of group A streptococcal (GAS) infections was noted in North Carolina. Ninety-six patients had GAS recovered from blood and other sterile body fluids, abscesses, and soft tissue. The overall case fatality rate was 11% but was much higher in patients with toxic shock syndrome (55%) and necrotizing fasciitis (58%). Recent invasive GAS isolates were compared with pre-1994 invasive isolates and temporally related pharyngeal isolates by M protein serotyping, pulsed field gel electrophoresis (PFGE), and polymerase chain reaction amplification of the streptococcal pyrogenic exotoxin A gene. Serotypes M1 and M3 accounted for 50% of recent invasive isolates (1994-1995) and 58% of pharyngeal isolates (1994). The latter isolates demonstrated PFGE patterns that were identical to invasive M1 and M3 strains, suggesting that pharyngeal infections may have served as a reservoir for virulent GAS clones.
authors.affiliation: University of North Carolina Hospitals, and Department of Microbiology/Immunology, University of North Carolina School of Medicine, Chapel Hill, USA.
authors.forename: D L
authors.initials: DL
authors.lastname: Kiska
authors.forename: B
authors.initials: B
authors.lastname: Thiede
authors.forename: J
authors.initials: J
authors.lastname: Caracciolo
authors.forename: M
authors.initials: M
authors.lastname: Jordan
authors.forename: D
authors.initials: D
authors.lastname: Johnson
authors.forename: E L
authors.initials: EL
authors.lastname: Kaplan
authors.forename: R P
authors.initials: RP
authors.lastname: Gruninger
authors.forename: J A
authors.initials: JA
authors.lastname: Lohr
authors.forename: P H
authors.initials: PH
authors.lastname: Gilligan
authors.forename: F W
authors.initials: FW
authors.lastname: Denny
mesh_terms: D000038:Abscess / Q000382:microbiology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000907:Antibodies, Bacterial / Q000032:analysis*; D016470:Bacteremia / Q000382:microbiology; D001426:Bacterial Proteins / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D004269:DNA, Bacterial / Q000032:analysis*; D016521:Electrophoresis, Gel, Pulsed-Field; D005098:Exotoxins / Q000235:genetics; D019115:Fasciitis, Necrotizing / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D007223:Infant; D008565:Membrane Proteins; D008875:Middle Aged; D017720:Molecular Epidemiology; D009657:North Carolina / Q000453:epidemiology; D010608:Pharyngeal Diseases / Q000382:microbiology; D016133:Polymerase Chain Reaction; D012772:Shock, Septic / Q000453:epidemiology / Q000382:microbiology; D018461:Soft Tissue Infections / Q000453:epidemiology / Q000382:microbiology; D013290:Streptococcal Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D013297:Streptococcus pyogenes / Q000235:genetics* / Q000276:immunology*
chemical_list: D000907:Antibodies, Bacterial; D001426:Bacterial Proteins; D004269:DNA, Bacterial; D005098:Exotoxins; D008565:Membrane Proteins; C117980:SpeA protein, Streptococcus pyogenes; C027951:erythrogenic toxin