Emergent Invasive Group A Streptococcus dysgalactiae subsp. equisimilis, United States, 2015-2018.

The term group A Streptococcus is considered synonymous for the species Streptococcus pyogenes. We describe an emergent invasive S. dysgalactiae subspecies equisimilis lineage that obtained the group A antigen through a single ancestral recombination event between a group C S. dysgalactiae subsp. equisimilis strain and a group A S. pyogenes strain.

Group B Streptococcus (GBS) Colonization and Disease among Pregnant Women: A Historical Cohort Study.

Background: Maternal GBS colonization is associated with early-onset neonatal sepsis and extensive efforts are directed to preventing this complication. Less is known about maternal risks of GBS colonization. We seek to provide a modern estimate of the incidence and impact of maternal GBS colonization and invasive GBS disease. Methods: A single center historical cohort study of all births between 2003 and 2015 was performed. Data was collected via electronic health record abstraction using an institutional specific tool. Descriptive statistics were performed regarding GBS status. Inferential statistics were performed comparing risk of adverse pregnancy outcomes in cohorts with and without GBS colonization as well as cohorts with GBS colonization and invasive GBS disease. Results: A total of 60,029 deliveries were included for analysis. Overall, 21.6% of the population was GBS colonized and 0.1% had invasive GBS disease. GBS colonization was associated with younger maternal age, Black race, non-Hispanic ethnicity, chronic hypertension, preexisting diabetes, and tobacco use (p<0.01). In the adjusted analyses, there was an increased risk of gestational diabetes (aRR 1.21, 95% CI 1.11-1.32) in colonized pregnancies and a decreased incidence of short cervix (aRR 0.64, 95% CI 0.52-0.79), chorioamnionitis (aRR 0.76, 95% CI 0.66-0.87), wound infection (aRR 0.75, 95% CI 0.64-0.88), and operative delivery (aRR 0.85, 95% CI 0.83-0.88). Conclusions: This modern-day large cohort of all births over a 12-year period demonstrates a GBS colonization rate of 21.6%. This data reflects a need to assess maternal and perinatal outcomes in addition to neonatal GBS sepsis rates to inform decisions regarding the utility of maternal vaccination.

Increased Risk for Invasive Group A Streptococcus Disease for Household Contacts of Scarlet Fever Cases, England, 2011-2016.

The incidence of scarlet fever in England and Wales is at its highest in 50 years. We estimated secondary household risk for invasive group A Streptococcus (iGAS) disease within 60 days after onset of scarlet fever. Reports of scarlet fever in England during 2011-2016 were matched by residential address to persons with laboratory-confirmed iGAS infections. We identified 11 iGAS cases in ≈189,684 household contacts and a 60-day incidence rate of 35.3 cases/100,000 person-years, which was 12.2-fold higher than the background rate (2.89). Infants and contacts >75 years of age were at highest risk. Three cases were fatal; sepsis and cellulitis were the most common manifestations. Typing for 6 iGAS cases identified emm 1.0 (n = 4), emm 4.0 (n = 1), and emm 12.0 (n = 1). Although absolute risk in household contacts was low, clinicians assessing household contacts should be aware of the risk to expedite diagnosis and initiate life-saving treatment.

Genomic epidemiological investigation of a Streptococcus suis outbreak in Guangxi, China, 2016.

In June 2016, a Streptococcus suis outbreak occurred in Guangxi, China. We determined the genetic characteristics of six clinically isolated strains by serotyping, PCR, and whole-genome sequencing, performing genome epidemiology analysis on these and 961 public available S. suis genomes. We also classified the first sequence type ST665 human case. Sporadic and outbreak cases were distinguished by whole-genome sequencing and phylogenomics. This approach could help to prevent and control S. suis epidemics in Guangxi and the wider region.

Clonal Clusters and Virulence Factors of Group C and G Streptococcus Causing Severe Infections, Manitoba, Canada, 2012-2014.

The incidence of group C and G Streptococcus (GCGS) bacteremia, which is associated with severe disease and death, is increasing. We characterized clinical features, outcomes, and genetic determinants of GCGS bacteremia for 89 patients in Winnipeg, Manitoba, Canada, who had GCGS bacteremia during 2012-2014. Of the 89 patients, 51% had bacteremia from skin and soft tissue, 70% had severe disease features, and 20% died. Whole-genome sequencing analysis was performed on isolates derived from 89 blood samples and 33 respiratory sample controls: 5 closely related genetic lineages were identified as being more likely to cause invasive disease than non-clade isolates (83% vs. 57%, p = 0.002). Virulence factors cbp, fbp, speG, sicG, gfbA, and bca clustered clonally into these clades. A clonal distribution of virulence factors may account for severe and fatal cases of bacteremia caused by invasive GCGS.

Clinical and microbiological features associated with group B Streptococcus bone and joint infections, France 2004-2014.

This study describes the clinical and microbiological features associated with group B Streptococcus (GBS) bone and joint infections (BJIs). It was a retrospective analysis of adult cases of GBS BJIs reported to the French National Reference Center for Streptococci from January 2004 to December 2014. Clinical data and GBS molecular characteristics are reported. Strains were collected from 163 patients. The most frequent comorbidities were: solid organ cancer (n = 21, 21%) and diabetes mellitus (n = 20, 20%). The main infection sites were knee (47/155 = 30%) and hip (43/155 = 27%), and occurred on orthopedic devices in 71/148 cases (48%). CPS III (n = 47, 29%), Ia (n = 26, 16%) and V (n = 40, 25%) were predominant. Resistance to erythromycin, clindamycin and tetracycline was detected in 55/163 (34%), 35/163 (21%) and 132/163 (81%) strains, respectively. The most frequent sequence types were ST-1 (n = 21, 25%), ST-17 (n = 17, 20%) and ST-23 (n = 11, 13%). The rate of resistance to erythromycin was 0% for ST-17 strains, 52% (n = 11) for ST-1 and 44% (n = 7) for ST-23 (p < 0.001). GBS bone and joint infections predominantly occur in patients aged >50 years and/or with comorbidities such as cancer and diabetes mellitus. CPS type distribution and MLST are very similar to that of other adult GBS invasive infections.

The virulence factors of group A streptococcus strains isolated from invasive and non-invasive infections in Polish and German centres, 2009-2011.

Streptococcus pyogenes (GAS) is one of the major human pathogenic bacteria that cause a wide range of diseases. Currently, increased incidence of streptococcal invasive infections is observed worldwide. In this study, we focused on the prevalence of genes encoding superantigens and type M proteins in the population of GAS strains from invasive versus non-invasive infections. We tested 253 GAS strains: 48 strains from patients with invasive infections (18 from wound/deep skin localization, 30 from women in labour) and 205 strains from non-invasive forms (147 from common infections of the upper respiratory, 49 from the vagina of females with genital tract infections and 9 from non-invasive wound and superficial skin infections). Significant differences were found in the occurrence of genes: speG, speI, speJ and smeZ, which were more common in GAS isolated from invasive than from non-invasive strains; speJ and smeZ occurred more frequently in strains from invasive perinatal infections versus strains from women without symptoms of invasive infection; speH and speI in strains from invasive skin/wound infection versus strains isolated from non-invasive wound and superficial skin infections. Emm types 1 and 12 predominated in the group of strains isolated from superficial infections and type 28 in those from puerperal fever. Occurrence of genes encoding virulence factors is common in genomic DNA of most of S. pyogenes, regardless whether these streptococcal infections are invasive or non-invasive. On the other hand, it appears that strains with speG, speI, speJ and smeZ genes may have a particular potential for virulence.

[The Cause of Death of Taira no Kiyomori: A Possible Connection with the Death of Fujiwara no Kunitsuna].

Taira no Kiyomori was struck by an unimaginable fever and died in the spring of Jisho Year 5 (1181). In the coup d'état of Jisho Year 3 (1179), Kiyomori ended the Go-shirakawa cloistered government through military force and established the Takakura cloistered government as a puppet regime in the following year. The regime lasted only a short while, however, as the retired Takakura Emperor passed away within less than a year. Kiyomori's death immediately followed the restoration of the Go-shirakawa cloistered government. The cause of Kiyomori's death has previously been discussed in the fields of literature and medicine and has been diagnosed variously as malaria, cerebrovascular disease, pneumonia, or meningitis contracted from complications of influenza, scarlatina fulminans (scarlet fever), and so on. However, considering the fact that Kiyomori--who was anxious about restoring relations with the retired Go-shirakawa Emperor as well as subjugation by the forces of the Minamoto clan, which were growing daily in strength--and his close aide Fujiwara no Kunitsuna simultaneously fell ill and died one after the other, it is speculated that both figures had streptococcal infection. It is, therefore, surmised that, during the clan's twilight years, Taira tactics were determined through secret discussions between Kiyomori and Kunitsuna.

Increased risk for group B Streptococcus sepsis in young infants exposed to HIV, Soweto, South Africa, 2004-2008(1).

Although group B Streptococcus (GBS) is a leading cause of severe invasive disease in young infants worldwide, epidemiologic data and knowledge about risk factors for the disease are lacking from low- to middle-income countries. To determine the epidemiology of invasive GBS disease among young infants in a setting with high maternal HIV infection, we conducted hospital-based surveillance during 2004-2008 in Soweto, South Africa. Overall GBS incidence was 2.72 cases/1,000 live births (1.50 and 1.22, respectively, among infants with early-onset disease [EOD] and late-onset [LOD] disease). Risk for EOD and LOD was higher for HIV-exposed than HIV-unexposed infants. GBS serotypes Ia and III accounted for 84.0% of cases, and 16.9% of infected infants died. We estimate that use of trivalent GBS vaccine (serotypes Ia, Ib, and III) could prevent 2,105 invasive GBS cases and 278 deaths annually among infants in South Africa; therefore, vaccination of all pregnant women in this country should be explored.

[The unexplained death of Blandine Liszt Ollivier]. / La mort inexpliquée de Blandine Liszt Ollivier.

Franz Liszt's eldest daughter, Blandine Ollivier, died at the age of 26, two months after the birth of her son Daniel. The reasons of that death remain obscure. There are contradictions between the asserted good health of Blandine during her pregnancy and what was learnt later on through the publication in French of Richard Wagner's autobiography. He was the husband of Cosima who was herself Blandine's sister. We put forward some hypotheses that can be discussed; Blandine would have contracted a serious anemia of pregnancy, unknown, with a streptococcus septicemia in post partum; no sign or symptom in consideration of mastitis carcinosis.

What causes decreased erythromycin resistance in Streptococcus pyogenes? Dynamics of four clones in a southern European region from 2005 to 2012.

OBJECTIVES: To survey antibiotic resistance among Streptococcus pyogenes isolates collected from 2005 to 2012, to characterize those showing erythromycin resistance and to analyse the association of certain emm types with erythromycin resistance or susceptibility. METHODS: Resistance determinants or mutations conferring erythromycin, clindamycin, tetracycline and fluoroquinolone resistance were analysed. All erythromycin-resistant isolates and a sample of erythromycin-susceptible isolates were emm typed. Multilocus sequence typing was performed for representative emm types. RESULTS: Antimicrobial susceptibility was studied for 12 346 S. pyogenes isolates. Erythromycin, clindamycin and tetracycline resistance showed a decreasing trend. In 2012, 2.8% of isolates were erythromycin resistant versus 7.5% in 2005 and 11.7% in 2006. Although 21 clones were involved, 4 clones accounted for almost 90% of erythromycin-resistant isolates. The emm12/ST36 clone, carrying the mef(A) gene, was the predominant (41.1%) erythromycin-resistant clone, with an incidence peak in 2008, followed by a gradual decline. The M phenotype predominated each year except for 2005, when two of the main erythromycin-resistant clones (emm11/ST403 and emm28/ST52) harboured an erm(B) gene. Erythromycin resistance was significantly higher in adults than in children. Skin isolates showed the highest erythromycin resistance rate; among these, perianal isolates frequently belonged to the emm28/ST52 clone. The emm type was not a predictor of erythromycin resistance; however, most emm11 and emm12 were erythromycin-resistant isolates. Macrolide consumption was similar throughout the study period. Only two isolates with a high level of levofloxacin resistance were detected. CONCLUSIONS: Resistance was mainly related to the circulation of emm12/ST36, emm11/ST403, emm28/ST52 and emm4/ST39 clones, all of which declined throughout the study period.

Cow's milk and the emergence of group B streptococcal disease in newborn babies.

BACKGROUND: Group B streptococcus (GBS), the most significant cause of neonatal bacterial sepsis, is thought to have emerged in the 1960s. GBS also causes mastitis in cows, and there is indirect evidence that human GBS is derived from a bovine ancestor. OBJECTIVE: A major change in the collection of milk from farms, using bulk tanks rather than churns, occurred in the 1960s. We sought to define the temporal relationship between this change in farming and the emergence of GBS neonatal disease. METHODS: We searched PubMed for reports of GBS disease from 1930 until 1980 to more exactly determine the time of emergence of neonatal infection and supported this data with UK hospital admission statistics for GBS infections. We identified the dates of the change from churns to bulk tanks by searching the internet and books for information on the history of milk transportation, farming and milk collection in the UK. RESULTS: There are no PubMed reports of neonatal GBS disease between 1930 and 1950, and reports from the UK only emerged in the mid-1960s, confirming the notion that GBS neonatal infection was a newly emergent disease in the 1960s. No national data on hospital admissions are available around this time, but the Oxford Record Linkage Study, with admission data available for Oxford from 1968, showed no cases of neonatal disease until 1974. Cow's milk collection in the UK switched to bulk tank between 1960 and 1979, and publications relating to GBS disease emerged soon after. CONCLUSIONS: There is a temporal relationship between the emergence of neonatal GBS disease reports in the UK in the 1960s and a change in cow's milk collection. This finding may be a temporal coincidence or may add support to the notion that human GBS was historically derived from a bovine ancestor.

Universal antenatal group B streptococcus screening? The opinions of obstetricians and neonatologists within Australia.

Group B streptococcus (GBS) is the leading infectious cause of morbidity and mortality in Australian newborns. Although intrapartum chemoprophylaxis is recommended to reduce the risk of neonatal GBS transmission and disease, controversy exists as to the best method to select women 'at risk' for this treatment. Our study aimed to survey the opinions of obstetricians and neonatologists currently in practice in Australia on GBS screening and treatment. Of the 488 obstetricians and 68 neonatologists currently in practice who responded to the survey, 271 obstetricians (56%) and 40 neonatologists (61%) supported universal antenatal screening. Of those respondents who did not support a universal antenatal screening policy, 196 (93%) and 24 (92%) of the obstetricians and neonatologists respectively, supported antenatal screening based on risk factors. This diversity in practitioner opinion highlights the lack of certainty in the literature as to the best management strategy to prevent neonatal GBS sepsis.