title: Clinical and microbiological characteristics of severe Streptococcus pyogenes disease in Europe.
abstract: In an attempt to compare the epidemiology of severe Streptococcus pyogenes infection within Europe, prospective data were collected through the Strep-EURO program. Surveillance for severe cases of S. pyogenes infection diagnosed during 2003 and 2004 was undertaken in 11 countries across Europe by using a standardized case definition and questionnaire. Patient data as well as bacterial isolates were collected and characterized by T and M/emm typing, and selected strains were analyzed for the presence of superantigen genes. Data were analyzed to compare the clinical and microbiological patterns of the infections across the participating countries. A total of 4,353 isolates were collected from 5,521 cases with severe S. pyogenes infections who were identified. A wide diversity of M/emm types (n = 104) was found among the S. pyogenes clinical isolates, but the M/emm type distribution varied broadly between participating countries. The 10 most predominant M/emm types were M/emm type 1 (M/emm1), M/emm28, M/emm3, M/emm89, M/emm87, M/emm12, M/emm4, M/emm83, M/emm81, and M/emm5, in descending order. A correlation was found between some specific disease manifestations, the age of the patients, and the emm types. Although streptococcal toxic shock syndrome and necrotizing fasciitis were caused by a large number of types, they were particularly associated with M/emm1 and M/emm3. The emm types included in the 26-valent vaccine under development were generally well represented in the present material; 16 of the vaccine types accounted for 69% of isolates. The Strep-EURO collaborative program has contributed to enhancement of the knowledge of the spread of invasive disease caused by S. pyogenes within Europe and encourages future surveillance by the notification of cases and the characterization of strains, which are important for vaccination strategies and other health care issues.
authors.affiliation: Department of Clinical Microbiology and Immunology, Lund University Hospital (USIL), Lund, Sweden.
authors.forename: Bogdan
authors.initials: B
authors.lastname: Luca-Harari
authors.forename: Jessica
authors.initials: J
authors.lastname: Darenberg
authors.forename: Shona
authors.initials: S
authors.lastname: Neal
authors.forename: Tuula
authors.initials: T
authors.lastname: Siljander
authors.forename: Lenka
authors.initials: L
authors.lastname: Strakova
authors.forename: Asha
authors.initials: A
authors.lastname: Tanna
authors.forename: Roberta
authors.initials: R
authors.lastname: Creti
authors.forename: Kim
authors.initials: K
authors.lastname: Ekelund
authors.forename: Maria
authors.initials: M
authors.lastname: Koliou
authors.forename: Panayotis T
authors.initials: PT
authors.lastname: Tassios
authors.forename: Mark
authors.initials: M
authors.lastname: van der Linden
authors.forename: Monica
authors.initials: M
authors.lastname: Straut
authors.forename: Jaana
authors.initials: J
authors.lastname: Vuopio-Varkila
authors.forename: Anne
authors.initials: A
authors.lastname: Bouvet
authors.forename: Androulla
authors.initials: A
authors.lastname: Efstratiou
authors.forename: Claes
authors.initials: C
authors.lastname: Schalén
authors.forename: Birgitta
authors.initials: B
authors.lastname: Henriques-Normark
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; D000942:Antigens, Bacterial / Q000235:genetics; D001425:Bacterial Outer Membrane Proteins / Q000235:genetics; D015373:Bacterial Typing Techniques; D002352:Carrier Proteins / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D005060:Europe / Q000453:epidemiology; D019115:Fasciitis, Necrotizing / Q000382:microbiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012772:Shock, Septic / Q000382:microbiology; D013290:Streptococcal Infections / Q000453:epidemiology* / Q000382:microbiology*; D013297:Streptococcus pyogenes / Q000145:classification* / Q000302:isolation & purification*; D018089:Superantigens / Q000235:genetics; D055815:Young Adult
chemical_list: D000942:Antigens, Bacterial; D001425:Bacterial Outer Membrane Proteins; D002352:Carrier Proteins; D018089:Superantigens; C014689:streptococcal M protein