TY - JOUR
T1 - Invasive group a streptococcal disease in Taiwan is not associated with the presence of streptococcal pyrogenic exotoxin genes
AU - Hsueh, Po Ren
AU - Wu, Jiunn Jong
AU - Tsai, Pei Jane
AU - Liu, Jien Wei
AU - Chuang, Yin Ching
AU - Luh, Kwen Tay
N1 - Funding Information:
Received 24 July 1997; revised 16 October 1997. Grant support: This work was supported in part by the National Science Council, Republic of China (NSC 85-2331-B-006-056). * Present address: Department of Internal Medicine, Chang Gung Memorial Hospital-Kaohsiung, Kaohsiung Hsien, Taiwan. Reprints or correspondence: Jiunn-Jong Wu, Ph.D., Department of Medical Technology, National Cheng Kung University Medical College, No. 1, University Road, Tainan, Taiwan.
PY - 1998
Y1 - 1998
N2 - We reviewed the clinical features of 44 patients with invasive group A streptococcal (GAS) disease who were treated at two teaching hospitals in southern Taiwan from 1991 to 1994. Genes encoding streptococcal pyrogenic exotoxin types A (speA), B (speB), C (speC), and F (speF) and serotypes of M1, M6, and M12 were determined by polymerase chain reaction to target specific sequences in the 44 isolates recovered from these patients and in 28 isolates recovered from upper respiratory sites in 28 additional patients during the study period. The protease activity of these isolates was tested by using the casein plate method. Of the 44 patients with invasive diseases, 25 (57%) had no obvious underlying diseases, and 14 (32%) had preexisting neoplastic diseases or had previously used steroids. Twenty-five patients (57%) presented with cellulitis or necrotizing fasciitis, 24 (55%) had bacteremia, and eight (189%) had streptococcal toxic shock syndrome (STSS). Eight patients (18%) died of invasive GAS disease; seven had STSS, and seven had underlying diseases. All eight patients died within 48 hours after hospitalization. The presence of speA, speC, or speF was not implicated in any particular clinical syndrome in patients with invasive GAS disease. High- level protease activity and the M1 serotype of the isolates were significantly associated with the clinical signs of STSS and with mortality. M1 serotype and protease activity, as well as host immune status, might play significant roles in the pathogenesis of invasive GAS disease in Taiwan.
AB - We reviewed the clinical features of 44 patients with invasive group A streptococcal (GAS) disease who were treated at two teaching hospitals in southern Taiwan from 1991 to 1994. Genes encoding streptococcal pyrogenic exotoxin types A (speA), B (speB), C (speC), and F (speF) and serotypes of M1, M6, and M12 were determined by polymerase chain reaction to target specific sequences in the 44 isolates recovered from these patients and in 28 isolates recovered from upper respiratory sites in 28 additional patients during the study period. The protease activity of these isolates was tested by using the casein plate method. Of the 44 patients with invasive diseases, 25 (57%) had no obvious underlying diseases, and 14 (32%) had preexisting neoplastic diseases or had previously used steroids. Twenty-five patients (57%) presented with cellulitis or necrotizing fasciitis, 24 (55%) had bacteremia, and eight (189%) had streptococcal toxic shock syndrome (STSS). Eight patients (18%) died of invasive GAS disease; seven had STSS, and seven had underlying diseases. All eight patients died within 48 hours after hospitalization. The presence of speA, speC, or speF was not implicated in any particular clinical syndrome in patients with invasive GAS disease. High- level protease activity and the M1 serotype of the isolates were significantly associated with the clinical signs of STSS and with mortality. M1 serotype and protease activity, as well as host immune status, might play significant roles in the pathogenesis of invasive GAS disease in Taiwan.
UR - http://www.scopus.com/inward/record.url?scp=0031978939&partnerID=8YFLogxK
U2 - 10.1086/514567
DO - 10.1086/514567
M3 - Article
C2 - 9524827
AN - SCOPUS:0031978939
SN - 1058-4838
VL - 26
SP - 584
EP - 589
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 3
ER -