title: Clinical and epidemiological aspects of invasive Streptococcus pyogenes infections in Denmark during 2003 and 2004.
abstract: Active surveillance of invasive group A streptococcal (GAS) infections was conducted in Denmark during 2003 and 2004 as a part of the Strep-EURO initiative. The main objective was to improve understanding of the epidemiology of invasive GAS disease in Denmark. During the 2 years, 278 cases were reported, corresponding to a mean annual incidence of 2.6 cases per 100,000 inhabitants. The vast majority of isolates, 253 (91%), were from blood, with the remaining 25 (9%) being from cerebrospinal fluid, joints, or other normally sterile sites. The mean case fatality rate (CFR) was 20%, with the rate being higher in patients more than 70 years of age (36.5%). For streptococcal toxic shock syndrome (STSS) and necrotizing fasciitis the CFRs were 53% and 25%, respectively. Out of 16 T types recorded, three predominated: T28 (23%), T1 (22%), and the cluster T3/13/B3264 (14%). Among 29 different emm types, emm28 and emm1 accounted for 51% of strains, followed by emm3 (11%), emm89 (7%), and emm12 (5.5%). Low resistance rates were detected for macrolide-lincosamide-streptogramin B (MLS(B)) antibiotics (3%) and tetracycline (8%); two isolates exhibited coresistance to tetracycline and macrolides. Of nine pyrogenic exotoxin (superantigen) genes examined, speA and speC were identified in 58% and 40% of the strains, respectively; either of the genes was present in all strains causing STSS. Most strains harbored speG (99%). ssa was present in 14% of the isolates only. In Denmark, as in comparable countries, GAS invasive disease shows a sustained, high endemicity, with involvement of both established and emerging streptococcal emm and T types.
authors.affiliation: Dept. of Medical Microbiology, Inst. of Laboratory Medicine, Lund University, Sölvegatan 23, 22362, Lund, Sweden.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Luca-Harari
authors.forename: Kim
authors.initials: K
authors.lastname: Ekelund
authors.forename: Mark
authors.initials: M
authors.lastname: van der Linden
authors.forename: Margit
authors.initials: M
authors.lastname: Staum-Kaltoft
authors.forename: Anette M
authors.initials: AM
authors.lastname: Hammerum
authors.forename: Aftab
authors.initials: A
authors.lastname: Jasir
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D000942:Antigens, Bacterial / Q000235:genetics; D001425:Bacterial Outer Membrane Proteins / Q000235:genetics; D001769:Blood / Q000382:microbiology; D002352:Carrier Proteins / Q000235:genetics; D002555:Cerebrospinal Fluid / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D004269:DNA, Bacterial / Q000235:genetics; D003718:Denmark / Q000453:epidemiology; D024881:Drug Resistance, Bacterial; D019353:Endemic Diseases; D019115:Fasciitis, Necrotizing / Q000382:microbiology / Q000401:mortality; D005260:Female; D005798:Genes, Bacterial / Q000235:genetics; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007596:Joints / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D017422:Sequence Analysis, DNA; D012703:Serotyping; D012772:Shock, Septic / Q000382:microbiology / Q000401:mortality; D013290:Streptococcal Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology*; D013297:Streptococcus pyogenes / Q000145:classification* / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents; D000942:Antigens, Bacterial; D001425:Bacterial Outer Membrane Proteins; D002352:Carrier Proteins; D004269:DNA, Bacterial; C014689:streptococcal M protein