title: Differences in the epidemiology between paediatric and adult invasive Streptococcus pyogenes infections.
abstract: In order to investigate for possible differences between paediatric and adult invasive Streptococcus pyogenes (iGAS) infections, a total of 142 cases were identified in 17 Greek hospitals during 2003-2007, of which 96 were children and 46 adults. Bacteraemia, soft tissue infections, streptococcal toxic shock syndrome (STSS), and necrotizing fasciitis were the main clinical presentations (67·6%, 45·1%, 13·4%, and 12·0% of cases, respectively). Bacteraemia and lymphadenitis were significantly more frequent in children (P=0·019 and 0·021, respectively), whereas STSS was more frequent in adults (P=0·017). The main predisposing factors in children were varicella and streptococcal pharyngotonsillitis (25% and 19·8%, respectively), as opposed to malignancy, intravenous drug abuse and diabetes mellitus in adults (19·6%, 15·2% and 10·9%, respectively). Of the two dominant emm-types, 1 and 12 (28·2% and 8·5%, respectively), the proportion of emm-type 12 remained stable during the study period, whereas emm-type 1 rates fluctuated considerably. Strains of emm-type 1 from children were associated with erythromycin susceptibility, STSS and intensive-care-unit admission, whereas emm-type 12 isolates from adults were associated with erythromycin and clindamycin resistance. Finally, specific emm-types were detected exclusively in adults or in children. In conclusion, several clinical and epidemiological differences were detected, that could prove useful in designing age-focused strategies for prevention and treatment of iGAS infections.
authors.affiliation: Department of Microbiology, Aghia Sophia Children's Hospital, Athens, Greece.
authors.forename: L
authors.initials: L
authors.lastname: Zachariadou
authors.affiliation: Department of Microbiology, Aghia Sophia Children's Hospital, Athens, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Stathi
authors.affiliation: Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: P T
authors.initials: PT
authors.lastname: Tassios
authors.affiliation: Department of Microbiology, Aghia Sophia Children's Hospital, Athens, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Pangalis
authors.affiliation: Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: N J
authors.initials: NJ
authors.lastname: Legakis
authors.affiliation: Department of Microbiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: J
authors.initials: J
authors.lastname: Papaparaskevas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000942:Antigens, Bacterial; D001425:Bacterial Outer Membrane Proteins; D002352:Carrier Proteins; D002648:Child; D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006115:Greece / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013290:Streptococcal Infections / Q000188:drug therapy / Q000453:epidemiology*; D013297:Streptococcus pyogenes / Q000187:drug effects / Q000302:isolation & purification*; D011795:Surveys and Questionnaires
chemical_list: D000942:Antigens, Bacterial; D001425:Bacterial Outer Membrane Proteins; D002352:Carrier Proteins; C014689:streptococcal M protein