title: Outbreak of Streptococcus pyogenes emm type 58 in a high dependency unit of a level-1 trauma center of India.
abstract: OBJECTIVE
  Group A Streptococcus (GAS) can cause illnesses ranging from self-limited to severe, life-threatening, invasive infections. The objective of the following study was to investigate a suspected Streptococcus pyogenes outbreak in a high dependency unit (HDU) of our trauma center.
  
  
  METHODS
  All the isolates of beta hemolytic Streptococci were identified by standard microbiological methods, Vitek 2 system and latex agglutination tests. Antimicrobial susceptibility testing was performed as recommended by Clinical Laboratory Standards Institute. Exotoxin genes, including speA, speB, speC, speF, smeZ, ssa, speG, speH, speJ, speL, speM and speI were detected by polymerase chain reaction (PCR). The emm types of isolates of S. pyogenes were determined by sequencing the variable 5' end of emm gene after amplification by PCR.
  
  
  RESULTS
  In a 28 bedded poly-trauma ward with a four bedded HDU three out of four patients developed S. pyogenes emm type 58 infection. The strain was macrolide and tetracycline resistant and produced the Streptococcal pyrogenic exotoxins speB, speC, speG, speF and smeZ. Surveillance sampling was done for investigation from patients, health-care workers and environmental samples.
  
  
  CONCLUSIONS
  An outbreak of GAS infections was established caused by the uncommonly reported emm type 58. The outbreak was controlled by prompt treatment, intensive surveillance, feedback and training.
authors.affiliation: Department of Laboratory Medicine, Microbiology Section, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Purva
authors.initials: P
authors.lastname: Mathur
authors.affiliation: Department of Laboratory Medicine, Microbiology Section, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Nidhi
authors.initials: N
authors.lastname: Bhardwaj
authors.affiliation: Department of Laboratory Medicine, Microbiology Section, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Gunjan
authors.initials: G
authors.lastname: Gupta
authors.affiliation: Department of Laboratory Medicine, Microbiology Section, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Parul
authors.initials: P
authors.lastname: Punia
authors.affiliation: Department of Laboratory Medicine, Microbiology Section, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Vibhor
authors.initials: V
authors.lastname: Tak
authors.affiliation: Department of Hospital Infection Control, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Nibu Varghese
authors.initials: NV
authors.lastname: John
authors.affiliation: Department of Neurosurgery, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Deepak
authors.initials: D
authors.lastname: Agrawal
authors.affiliation: Department of Surgery, Jai Prakash Narain Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Manesh C
authors.initials: MC
authors.lastname: Misra
keywords: Beta-hemolytic Streptococci; Streptococcus pyrogenic exotoxins emm types; group A Streptococcus; outbreak; trauma patients