495. Epidemiology and Early Clinical Presentations of Invasive Group A Streptococcal Diseases
Session: Poster Abstract Session: Public Health
Thursday, October 3, 2013
Room: The Moscone Center: Poster Hall C
  • 2013-10-03 IDSA GAS Epidemiology Early Presentation [Compatibility Mode].pdf (345.9 kB)
  • Background: Invasive Group A Streptococcal (iGAS) diseases are associated with increased risk for mortality, particularly among certain GAS emm types (emm1, -3, -12). There is a lack of detailed information on the early signs and symptoms of iGAS. Objective: To determine early clinical, laboratory, and patient characteristics associated with toxin mediated syndrome (TMS) or death to allow earlier diagnosis and treatment.

    Methods: Retrospective chart review (Jan. 2008 - Dec. 2011) was conducted on patients with iGAS from 8 Albany area counties of NY State (NYS). iGAS disease was defined as isolation of Streptococcus pyogenes from a normally sterile site or from non-sterile site with necrotizing fasciitis or toxic shock syndrome. iGAS isolates were sent to CDC (EIPs Active Bacterial Core) for susceptibility and emm typing. Tabular methods were used to characterize clinic presentations and GAS isolates. Logistic regression was performed to determine the risk of TMS or death. Statistical analyses were performed using SASv9.2.

    Results: There were 73 patients with iGAS disease, 30 with TMS (41%), majority were male (n=39, 53%), white (n=62, 85%), non-Hispanic (n=47, 64%), and >18 years (n=60, 82%). GAS was isolated from blood in 75% of patients. The overall case fatality rate was 12.3% compared to 26.3% among patients with TMS. A majority of patients (n=70, 96%) had healthcare encounters within 4 days prior to hospitalization. The most common presentations before hospitalization were cutaneous (n=54, 74%), fever/chills (n=44, 60%), & muscle/joint pains (n=20, 27%). Patients with fever/chills had lower odds of mortality (OR 0.2; 95%CI, 0.0-0.8). Multiorgan involvement & bandemia >10% was associated with TMS (OR 8.4; 95%CI, 2.7-26.4). All viable isolates (n=72) were penicillin susceptible & ~6% (n=4) were clindamycin resistant. The majority (59%) of cases were emm types 1, -2, -3, -12, & -28. The use of clindamycin (OR 0.21; 95%CI, 0.05-0.94) and having an infectious disease (ID) consultation (OR 0.1; 95%CI, 0.0-0.6) improved the odds of survival.

    Conclusion: Early clinical presentations of iGAS diseases were non-specific but the presence of skin, fever/chills, and muscle/joint manifestations with elevated bands (>10%) should increase suspicion for TMS. In the event of a suspect or confirmed case of iGAS, the use of clindamycin and ID consultation should be considered.

    Roberto P. Santos, MD, MSc1, Nancy L. Spina, MPH2, Danielle S. Abraham, MPH, CSTE Fellow2, Debra A. Simmerly, RN CIC3, Shelley M. Zansky, PhD2 and Sarah L. Elmendorf, MD4, (1)Pediatrics, Albany Medical Center, Albany, NY, (2)Emerging Infections Program, New York State Department of Health, Albany, NY, (3)Healthcare Epidemiology and Infection Control, New York State Department of Health, Albany, NY, (4)Epidemiology, Albany Medical Center, Albany, NY


    R. P. Santos, None

    N. L. Spina, None

    D. S. Abraham, None

    D. A. Simmerly, None

    S. M. Zansky, None

    S. L. Elmendorf, None

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