Increased Prevalence of Group A Streptococcus Isolates in Streptococcal Toxic Shock Syndrome Cases in Japan from 2010 to 2012

Overview

Journal Epidemiol Infect

Publisher Cambridge University Press

Specialties Infectious Diseases
Public Health

Date 2015 Feb 24

PMID 25703404

Citations 29

Authors

T Ikebe

K Tominaga

T Shima

R Okuno

H Kubota

K Ogata

K Chiba

C Katsukawa

H Ohya

Y Tada

N Okabe

H Watanabe

M Ogawa

M Ohnishi

Affiliations

Soon will be listed here.

Abstract

Streptococcal toxic shock syndrome (STSS) is a severe invasive infection characterized by the sudden onset of shock, multi-organ failure, and high mortality. In Japan, appropriate notification measures based on the Infectious Disease Control law are mandatory for cases of STSS caused by β-haemolytic streptococcus. STSS is mainly caused by group A streptococcus (GAS). Although an average of 60-70 cases of GAS-induced STSS are reported annually, 143 cases were recorded in 2011. To determine the reason behind this marked increase, we characterized the emm genotype of 249 GAS isolates from STSS patients in Japan from 2010 to 2012 and performed antimicrobial susceptibility testing. The predominant genotype was found to be emm1, followed by emm89, emm12, emm28, emm3, and emm90. These six genotypes constituted more than 90% of the STSS isolates. The number of emm1, emm89, emm12, and emm28 isolates increased concomitantly with the increase in the total number of STSS cases. In particular, the number of mefA-positive emm1 isolates has escalated since 2011. Thus, the increase in the incidence of STSS can be attributed to an increase in the number of cases associated with specific genotypes.

Citing Articles

A comprehensive analysis of antimicrobial resistance of clinical 89 in Japan.

Gong W, Ono M, Yamaguchi M, Motooka D, Hirose Y, Higashi K JAC Antimicrob Resist. 2025; 7(1):dlaf017.

PMID: 39973909 PMC: 11836879. DOI: 10.1093/jacamr/dlaf017.

Cardiac rupture and toxic shock syndrome by invasive group a Streptococcus in a Fontan patient with Asplenia syndrome.

Muraoka M, Tetsuhara K, Suzuki S, Yamamura K, Nakano T, Onoyama S J Cardiol Cases. 2025; 31(1):24-28.

PMID: 39839734 PMC: 11745787. DOI: 10.1016/j.jccase.2024.09.009.

Trends in the growing impact of group A Streptococcus infection on public health after COVID-19 pandemic: a multicentral observational study in Okayama, Japan.

Fukushima S, Saito T, Iwamoto Y, Takehara Y, Yamada H, Fujita K Eur J Clin Microbiol Infect Dis. 2024; 44(2):383-391.

PMID: 39680263 PMC: 11754343. DOI: 10.1007/s10096-024-05015-2.

Toxic Shock Syndrome (TSS) Caused by Group A : Novel Insights Within the Context of a Familiar Clinical Syndrome.

Kim T J Korean Med Sci. 2024; 39(17):e154.

PMID: 38711318 PMC: 11074494. DOI: 10.3346/jkms.2024.39.e154.

A Review of the Impact of Streptococcal Infections and Antimicrobial Resistance on Human Health.

Gergova R, Boyanov V, Muhtarova A, Alexandrova A Antibiotics (Basel). 2024; 13(4).

PMID: 38667036 PMC: 11047474. DOI: 10.3390/antibiotics13040360.

References

Ghosh P . The nonideal coiled coil of M protein and its multifarious functions in pathogenesis. Adv Exp Med Biol. 2011; 715:197-211. PMC: 5541941. DOI: 10.1007/978-94-007-0940-9_12. View

MULLER-EBERHARD H . The membrane attack complex of complement. Annu Rev Immunol. 1986; 4:503-28. DOI: 10.1146/annurev.iy.04.040186.002443. View

Miyamoto Y, Takizawa K, Matsushima A, Asai Y, Nakatsuka S . Stepwise acquisition of multiple drug resistance by beta-hemolytic streptococci and difference in resistance pattern by type. Antimicrob Agents Chemother. 1978; 13(3):399-404. PMC: 352252. DOI: 10.1128/AAC.13.3.399. View

Liang Y, Liu X, Chang H, Ji L, Huang G, Fu Z . Epidemiological and molecular characteristics of clinical isolates of Streptococcus pyogenes collected between 2005 and 2008 from Chinese children. J Med Microbiol. 2012; 61(Pt 7):975-983. DOI: 10.1099/jmm.0.042309-0. View

Eriksson B, Andersson J, Holm S, Norgren M . Epidemiological and clinical aspects of invasive group A streptococcal infections and the streptococcal toxic shock syndrome. Clin Infect Dis. 1998; 27(6):1428-36. DOI: 10.1086/515012. View

Hoge C, Schwartz B, Talkington D, Breiman R, MacNeill E, Englender S . The changing epidemiology of invasive group A streptococcal infections and the emergence of streptococcal toxic shock-like syndrome. A retrospective population-based study. JAMA. 1993; 269(3):384-9. View

Patel R, Binns H, Shulman S . Reduction in pediatric hospitalizations for varicella-related invasive group A streptococcal infections in the varicella vaccine era. J Pediatr. 2004; 144(1):68-74. DOI: 10.1016/j.jpeds.2003.10.025. View

Bingen E, Bidet P, Mihaila-Amrouche L, Doit C, Forcet S, Brahimi N . Emergence of macrolide-resistant Streptococcus pyogenes strains in French children. Antimicrob Agents Chemother. 2004; 48(9):3559-62. PMC: 514735. DOI: 10.1128/AAC.48.9.3559-3562.2004. View

Steer A, Lamagni T, Curtis N, Carapetis J . Invasive group a streptococcal disease: epidemiology, pathogenesis and management. Drugs. 2012; 72(9):1213-27. PMC: 7100837. DOI: 10.2165/11634180-000000000-00000. View

10.

Dale J, Fischetti V, Carapetis J, Steer A, Sow S, Kumar R . Group A streptococcal vaccines: paving a path for accelerated development. Vaccine. 2013; 31 Suppl 2:B216-22. DOI: 10.1016/j.vaccine.2012.09.045. View

11.

Smeesters P, McMillan D, Sriprakash K . The streptococcal M protein: a highly versatile molecule. Trends Microbiol. 2010; 18(6):275-82. DOI: 10.1016/j.tim.2010.02.007. View

12.

Ikebe T, Oguro Y, Ogata K, Katsukawa C, Isobe J, Shima T . Surveillance of severe invasive group G streptococcal infections in Japan during 2002-2008. Jpn J Infect Dis. 2010; 63(5):372-5. View

13.

Martin J, Murchan S, OFlanagan D, Fitzpatrick F . Invasive Group A streptococcal disease in Ireland, 2004 to 2010. Euro Surveill. 2011; 16(41). View

14.

Sutcliffe J, Grebe T, Tait-Kamradt A, Wondrack L . Detection of erythromycin-resistant determinants by PCR. Antimicrob Agents Chemother. 1996; 40(11):2562-6. PMC: 163576. DOI: 10.1128/AAC.40.11.2562. View

15.

de Azavedo J, Yeung R, Bast D, Duncan C, Borgia S, Low D . Prevalence and mechanisms of macrolide resistance in clinical isolates of group A streptococci from Ontario, Canada. Antimicrob Agents Chemother. 1999; 43(9):2144-7. PMC: 89437. DOI: 10.1128/AAC.43.9.2144. View

16.

Mejia L, Stockbauer K, Pan X, Cravioto A, Musser J . Characterization of group A Streptococcus strains recovered from Mexican children with pharyngitis by automated DNA sequencing of virulence-related genes: unexpectedly large variation in the gene (sic) encoding a complement-inhibiting protein. J Clin Microbiol. 1997; 35(12):3220-4. PMC: 230151. DOI: 10.1128/jcm.35.12.3220-3224.1997. View

17.

Ikebe T, Wada A, Oguro Y, Ogata K, Katsukawa C, Isobe J . Emergence of clindamycin-resistant Streptococcus pyogenes isolates obtained from patients with severe invasive infections in Japan. Jpn J Infect Dis. 2010; 63(4):304-5. View

18.

McMillan D, Dreze P, Vu T, Bessen D, Guglielmini J, Steer A . Updated model of group A Streptococcus M proteins based on a comprehensive worldwide study. Clin Microbiol Infect. 2013; 19(5):E222-9. PMC: 4568957. DOI: 10.1111/1469-0691.12134. View

19.

. Defining the group A streptococcal toxic shock syndrome. Rationale and consensus definition. The Working Group on Severe Streptococcal Infections. JAMA. 1993; 269(3):390-1. View

20.

Beall B, Facklam R, Thompson T . Sequencing emm-specific PCR products for routine and accurate typing of group A streptococci. J Clin Microbiol. 1996; 34(4):953-8. PMC: 228924. DOI: 10.1128/jcm.34.4.953-958.1996. View