Invasive group A streptococcal disease in metropolitan Atlanta: a population-based assessment.
Active, population-based surveillance for invasive group A streptococcal (GAS) disease was conducted in laboratories in metropolitan Atlanta from 1 January 1994 through 30 June 1995. Clinical and laboratory records were reviewed and isolates characterized. One hundred and eighty-three cases of invasive GAS disease were identified (annual incidence, 5.2 cases/100,000). The incidence was highest among blacks (9.7/100,000 per year; relative risk (RR), 1.92; confidence interval (CI), 1.69-2.19; P < .0001) and the elderly, particularly nursing home residents (RR, 13.66; CI, 7.07-26.40; P < .0001). The mean age of patients was 41.3 years (range, 0-95 years). Skin and soft-tissue infections were most common. Mortality was 14.4%; risk of death was significantly higher for patients with streptococcal toxic shock syndrome (STSS) (RR, 9.73; CI, 3.34-29; P = .0008) and individuals infected with M-type 1 (RR, 7.40; CI, 1.5-16; P = .0084). Fourteen percent of invasive GAS infections were STSS and 3% were necrotizing fasciitis. Invasive GAS disease was associated with varicella infection in children (RR, 12.19; CI, 5.58-26.62; P < .0001). M (or emm) types included M1 (16%), M12 (12%), and M3 (11%). Continued study of GAS disease is essential to further define risk factors and risk of secondary cases and to develop effective prevention strategies.
Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA.
C A
CA
Zurawski
M
M
Bardsley
B
B
Beall
J A
JA
Elliott
R
R
Facklam
B
B
Schwartz
M M
MM
Farley
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004269:DNA, Bacterial / Q000032:analysis; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D011159:Population Surveillance; D012307:Risk Factors; D013290:Streptococcal Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D013297:Streptococcus pyogenes / Q000302:isolation & purification; D014505:Urban Population
D004269:DNA, Bacterial