title: Invasive group A streptococcal disease in the Netherlands: evidence for a protective role of anti-exotoxin A antibodies.
abstract: As part of a nationwide surveillance in The Netherlands during 1994-1997, 53 patients with invasive group A streptococcal (GAS) infections were evaluated for medical history, symptoms, and outcome. Patients' isolates were tested for the production of pyrogenic exotoxins A (SPE-A) and B (SPE-B). Acute-phase sera from all patients and convalescent sera from 12 patients were investigated for the presence of antibodies against SPE-A and SPE-B. Twenty-three patients developed toxic shock-like syndrome and 16 died. Absence of antibodies against SPE-A and/or SPE-B was a risk factor for developing invasive streptococcal disease. Toxic shock and mortality were associated with a lack of anti-SPE-A antibodies (P<.025). Anti-SPE-A antibodies were found in convalescent sera from all patients infected by speA-positive isolates. Virtually all invasive speA-positive streptococci expressed SPE-A protein in vitro. Thus antibodies against SPE-A appeared vital for mediating the outcome of invasive GAS disease in this population.
authors.affiliation: Eijkman-Winkler Institute for Microbiology, Infectious Diseases, and Inflammation, Utrecht University Hospital, NL-3508 GA Utrecht, The Netherlands. E.M.Mascini@lab.azu.nl
authors.forename: E M
authors.initials: EM
authors.lastname: Mascini
authors.forename: M
authors.initials: M
authors.lastname: Jansze
authors.forename: J F
authors.initials: JF
authors.lastname: Schellekens
authors.forename: J M
authors.initials: JM
authors.lastname: Musser
authors.forename: J A
authors.initials: JA
authors.lastname: Faber
authors.forename: L A
authors.initials: LA
authors.lastname: Verhoef-Verhage
authors.forename: L
authors.initials: L
authors.lastname: Schouls
authors.forename: W J
authors.initials: WJ
authors.lastname: van Leeuwen
authors.forename: J
authors.initials: J
authors.lastname: Verhoef
authors.forename: H
authors.initials: H
authors.lastname: van Dijk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000907:Antibodies, Bacterial / Q000097:blood* / Q000276:immunology; D016470:Bacteremia / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D001426:Bacterial Proteins; D002648:Child; D002675:Child, Preschool; D004797:Enzyme-Linked Immunosorbent Assay; D005098:Exotoxins / Q000096:biosynthesis / Q000276:immunology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008565:Membrane Proteins; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011159:Population Surveillance; D011379:Prognosis; D012772:Shock, Septic / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D013290:Streptococcal Infections / Q000175:diagnosis / Q000453:epidemiology / Q000276:immunology* / Q000382:microbiology*; D013297:Streptococcus pyogenes / Q000302:isolation & purification* / Q000378:metabolism
chemical_list: D000907:Antibodies, Bacterial; D001426:Bacterial Proteins; D005098:Exotoxins; D008565:Membrane Proteins; C117980:SpeA protein, Streptococcus pyogenes; C027951:erythrogenic toxin