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Journal of Clinical Microbiology, April 2009, p. 1155-1165, Vol. 47, No. 4
0095-1137/09/$08.00+0     doi:10.1128/JCM.02155-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.

Clinical and Microbiological Characteristics of Severe Streptococcus pyogenes Disease in Europe

Bogdan Luca-Harari,^1, Jessica Darenberg,^2, Shona Neal,³ Tuula Siljander,⁴ Lenka Strakova,⁵ Asha Tanna,³ Roberta Creti,⁶ Kim Ekelund,⁷ Maria Koliou,⁸ Panayotis T. Tassios,⁹ Mark van der Linden,¹⁰ Monica Straut,¹¹ Jaana Vuopio-Varkila,⁴ Anne Bouvet,¹² Androulla Efstratiou,³ Claes Schalén,¹ Birgitta Henriques-Normark,² the Strep-EURO Study Group , and Aftab Jasir^1,13*

Department of Laboratory Medicine, Division of Medical Microbiology, Lund University, Lund, Sweden,¹ Swedish Institute for Infectious Disease Control and MTC Karolinska Institutet, Solna, Sweden,² Respiratory and Systemic Infections Laboratory, Health Protection Agency, London, United Kingdom,³ National Public Health Institute, Helsinki, Finland,⁴ National Institute of Public Health, Prague, Czech Republic,⁵ Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy,⁶ Statens Serum Institut, Copenhagen, Denmark,⁷ Archbishop Makarios Hospital, Nicosia, Cyprus,⁸ University of Athens, Athens, Greece,⁹ German National Reference Center for Streptococci, Department of Medical Microbiology, University Hospital RWTH Aachen, Aachen, Germany,¹⁰ Molecular Epidemiology Laboratory, Cantacuzino Institute, Bucharest, Romania,¹¹ National Reference Center for Streptococci, Associated Laboratory for Group A Streptococci, Department of Microbiology, Hotel Dieu AP-HP, Paris Descartes University, Paris, France,¹² Clinical Microbiology and Immunology, Lund University Hospital (USIL), Lund, Sweden,¹³

Received 11 November 2008/ Returned for modification 17 December 2008/ Accepted 9 January 2009

In an attempt to compare the epidemiology of severe Streptococcus pyogenes infection within Europe, prospective data were collected through the Strep-EURO program. Surveillance for severe cases of S. pyogenes infection diagnosed during 2003 and 2004 was undertaken in 11 countries across Europe by using a standardized case definition and questionnaire. Patient data as well as bacterial isolates were collected and characterized by T and M/emm typing, and selected strains were analyzed for the presence of superantigen genes. Data were analyzed to compare the clinical and microbiological patterns of the infections across the participating countries. A total of 4,353 isolates were collected from 5,521 cases with severe S. pyogenes infections who were identified. A wide diversity of M/emm types (n = 104) was found among the S. pyogenes clinical isolates, but the M/emm type distribution varied broadly between participating countries. The 10 most predominant M/emm types were M/emm type 1 (M/emm1), M/emm28, M/emm3, M/emm89, M/emm87, M/emm12, M/emm4, M/emm83, M/emm81, and M/emm5, in descending order. A correlation was found between some specific disease manifestations, the age of the patients, and the emm types. Although streptococcal toxic shock syndrome and necrotizing fasciitis were caused by a large number of types, they were particularly associated with M/emm1 and M/emm3. The emm types included in the 26-valent vaccine under development were generally well represented in the present material; 16 of the vaccine types accounted for 69% of isolates. The Strep-EURO collaborative program has contributed to enhancement of the knowledge of the spread of invasive disease caused by S. pyogenes within Europe and encourages future surveillance by the notification of cases and the characterization of strains, which are important for vaccination strategies and other health care issues.

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* Corresponding author. Mailing address: Department of Clinical Microbiology and Immunology, Lund University Hospital (USIL), Sölvegatan 23, Lund 23362, Sweden. Phone: 46 46 173286. Fax: 46 46 135936. E-mail: aftab.jasir{at}med.lu.se

Published ahead of print on 21 January 2009.

The first two authors contributed equally to this study.

The contributing members of the Strep-EURO study group (in addition to the authors of this paper) include Nasia Hannidou from Cyprus; Paula Kriz and Jitka Motlova from the Czech Republic; Margit S. Kaltoft from Denmark; Joonas Iivonen and Jari Jalava from Finland; Julien Loubinoux and Liliana Mihaila from France; Rudolf Lütticken and Ralf René Reinert from Germany; Joseph Papaparaskevas, Levantia Zacharidou, and Nicholas J. Legakis from Greece; Lucilla Baldassarri, Monica Imperi, and Graziella Orefici from Italy; Vasilica Ungureanu from Romania; Anna Norrby-Teglund and Lars Björck from Sweden; and Neelam Alhaddad, Michaela Emery, Catherine Keshishian, and Theresa Lamagni from the United Kingdom.

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Journal of Clinical Microbiology, April 2009, p. 1155-1165, Vol. 47, No. 4
0095-1137/09/$08.00+0     doi:10.1128/JCM.02155-08
Copyright © 2009, American Society for Microbiology. All Rights Reserved.

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