title: Management of Contacts of Patients With Severe Invasive Group A Streptococcal Infection.
abstract: BACKGROUND
  Conflicting recommendations regarding antibiotic prophylaxis for contacts of patients with invasive group A streptococcal (GAS) infection exist. Close contacts of patients with such severe and rapidly progressive disease often strongly appeal to the treating clinicians for antimicrobial treatment to prevent additional cases. We aimed to use an approach based on pharyngeal culture testing of contacts and targeted antibiotic prophylaxis.
  
  
  METHODS
  A large throat swab survey including 105 contacts was undertaken after a fulminant and fatal case of GAS necrotizing fasciitis. GAS strains were characterized by emm typing and antimicrobial susceptibility to 7 antibiotics. The presence of 30 virulence determinants was determined by polymerase chain reaction and sequencing.
  
  
  RESULTS
  The GAS isolate recovered from the index patient was an M1T1 GAS clone susceptible to all antimicrobial agents tested. The same clone was present in the throat of 36% of close contacts who had exposure to the index patient (family households and classroom contacts) for >24 hours/week, whereas the strain was present in only 2% of the other contacts.
  
  
  CONCLUSIONS
  Although the study does not allow firm conclusions to be drawn as to whether antibiotic prophylaxis is effective, we describe a practical approach, including an educational campaign and targeted antibiotic treatment to close contacts who have been exposed to an index patient for > 24 hours/week before the initial disease onset.
authors.affiliation: Laboratório de Bacteriologia, Divisão de Laboratórios de Epidemiologia e Controle de Doenças, Laboratório Central do Estado do Paraná Universidade Positivo, Curitiba.
authors.forename: Rosângela Stadnick Lauth
authors.initials: RS
authors.lastname: de Almeida Torres
authors.affiliation: Pontifícia Universidade Católica do Paraná
authors.forename: Talita Zajac
authors.initials: TZ
authors.lastname: dos Santos
authors.affiliation: Universidade Positivo, Curitiba.
authors.forename: Robson Antônio de Almeida
authors.initials: RA
authors.lastname: Torres
authors.affiliation: Hospital Vita, Curitiba.
authors.forename: Lygia Maria Coimbra de Manuel
authors.initials: LM
authors.lastname: Petrini
authors.affiliation: Secretaria Municipal de Curitiba Associação Hospitalar de Proteção a Infância Dr Raul Carneiro, Curitiba, Paraná, Brazil.
authors.forename: Marion
authors.initials: M
authors.lastname: Burger
authors.affiliation: Centre for International Child Health, University of Melbourne Group A Streptococcal Research Group, Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Steer
authors.affiliation: Centre for International Child Health, University of Melbourne Group A Streptococcal Research Group, Murdoch Children's Research Institute, Parkville, Melbourne, Victoria, Australia Laboratory of Bacterial Genetics and Physiology, IBMM, Faculté des Sciences, Université Libre de Bruxelles, Brussels, Belgium.
authors.forename: Pierre R
authors.initials: PR
authors.lastname: Smeesters
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; 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; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000473:pathology / Q000517:prevention & control / Q000635:transmission; D019115:Fasciitis, Necrotizing / Q000382:microbiology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D010353:Patient Education as Topic; D010614:Pharynx / Q000382:microbiology; D013290:Streptococcal Infections / Q000188:drug therapy / Q000473:pathology / Q000517:prevention & control* / Q000635:transmission*; D013297:Streptococcus pyogenes / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification / Q000472:pathogenicity; D014774:Virulence; D037521:Virulence Factors / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D000942:Antigens, Bacterial; D001425:Bacterial Outer Membrane Proteins; D002352:Carrier Proteins; D037521:Virulence Factors; C014689:streptococcal M protein
keywords: close contacts; group A streptococcus; necrotizing fasciitis; prevention; throat swab