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Journal of Clinical Microbiology, January 2008, p. 79-86, Vol. 46, No. 1
0095-1137/08/$08.00+0     doi:10.1128/JCM.01626-07
Copyright © 2008, American Society for Microbiology. All Rights Reserved.

Clinical and Epidemiological Aspects of Invasive Streptococcus pyogenes Infections in Denmark during 2003 and 2004{triangledown}

Bogdan Luca-Harari,1 Kim Ekelund,2,5 Mark van der Linden,3 Margit Staum-Kaltoft,2 Anette M. Hammerum,4 and Aftab Jasir1*

Department of Medical Microbiology, Institute of Laboratory Medicine, Lund University, Lund, Sweden,1 Streptococcus Unit, Statens Serum Institut, Copenhagen, Denmark,2 German National Reference Center for Streptococci, Department of Medical Microbiology, University Hospital RWTH Aachen, Aachen, Germany,3 National Center for Antimicrobials and Infection Control, Statens Serum Institut, Copenhagen, Denmark,4 Department of Anaesthesia and Intensive Care, Copenhagen University Hospital Gentofte, Copenhagen, Denmark5

Received 15 August 2007/ Returned for modification 30 September 2007/ Accepted 10 October 2007

Active surveillance of invasive group A streptococcal (GAS) infections was conducted in Denmark during 2003 and 2004 as a part of the Strep-EURO initiative. The main objective was to improve understanding of the epidemiology of invasive GAS disease in Denmark. During the 2 years, 278 cases were reported, corresponding to a mean annual incidence of 2.6 cases per 100,000 inhabitants. The vast majority of isolates, 253 (91%), were from blood, with the remaining 25 (9%) being from cerebrospinal fluid, joints, or other normally sterile sites. The mean case fatality rate (CFR) was 20%, with the rate being higher in patients more than 70 years of age (36.5%). For streptococcal toxic shock syndrome (STSS) and necrotizing fasciitis the CFRs were 53% and 25%, respectively. Out of 16 T types recorded, three predominated: T28 (23%), T1 (22%), and the cluster T3/13/B3264 (14%). Among 29 different emm types, emm28 and emm1 accounted for 51% of strains, followed by emm3 (11%), emm89 (7%), and emm12 (5.5%). Low resistance rates were detected for macrolide-lincosamide-streptogramin B (MLSB) antibiotics (3%) and tetracycline (8%); two isolates exhibited coresistance to tetracycline and macrolides. Of nine pyrogenic exotoxin (superantigen) genes examined, speA and speC were identified in 58% and 40% of the strains, respectively; either of the genes was present in all strains causing STSS. Most strains harbored speG (99%). ssa was present in 14% of the isolates only. In Denmark, as in comparable countries, GAS invasive disease shows a sustained, high endemicity, with involvement of both established and emerging streptococcal emm and T types.

* Corresponding author. Mailing address: Dept. of Medical Microbiology, Inst. of Laboratory Medicine, Lund University, Sölvegatan 23, 22362, Lund, Sweden. Phone: 46-46173286. Fax: 46-46135936. E-mail: aftab.jasir{at}med.lu.se

{triangledown} Published ahead of print on 24 October 2007.

Journal of Clinical Microbiology, January 2008, p. 79-86, Vol. 46, No. 1
0095-1137/08/$08.00+0     doi:10.1128/JCM.01626-07
Copyright © 2008, American Society for Microbiology. All Rights Reserved.



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