Martin P R, Høiby E A
Department of Infectious Disease Control, National Institute of Public Health, Oslo, Norway.
Scand J Infect Dis. 1990;22(4):421-9. doi: 10.3109/00365549009027073.
A nationwide outbreak of Lancefield group A streptococcal (GAS) infections in Norway during the season 1987-88 is described. Data were collected from the Norwegian infectious disease notification system and supplemented by active search for cases of bacteraemia and other serious infections in addition to serotyping of selected clinical bacterial isolates. The number of reported cases of non-invasive GAS infections from week 29/1987 to week 28/1988 was 60% higher than expected. Between 1 Jan. and 30 June 1988, 84 cases of bacteraemia were notified, several with fulminant septicaemia and shock. The case fatality rate was 25%. Six cases of neonatal GAS septicaemia were seen. There was a nearly 3-fold total increase in occurrence of GAS bacteraemia compared with previous years, and the increase was marked particularly in cases among older children and adults 30-50 years old. Additional culture-confirmed diagnoses included unusual cases compared to recent decades such as pneumonia with empyema, necrotising fasciitis and primary peritonitis. Serotyping of strains collected consecutively from localized infections revealed a marked predominance of T-type 1, opacity factor negative strains (T-1 OF-), ranging from 41% in North Norway to 87% in Mid-Norway. M-typing confirmed that these strains were M-1, as were 87% of the preserved bacteraemia strains from the period described. Although most of the M-1 strains were distinctly mucoid only one case of acute rheumatic fever was reported during the first half of 1988. We conclude that an epidemic of GAS infections caused by M-1 strains has occurred in Norway resulting in an increase in both incidence and seriousness of disease.
本文描述了1987 - 1988年期间挪威全国范围内A群链球菌（GAS）感染的爆发情况。数据收集自挪威传染病报告系统，并通过主动搜索菌血症及其他严重感染病例进行补充，同时对部分临床分离细菌进行血清分型。1987年第29周（至）1988年第28周报告的非侵袭性GAS感染病例数比预期高出60%。1988年1月1日至6月30日，报告了84例菌血症病例，其中数例为暴发性败血症和休克。病死率为25%。发现6例新生儿GAS败血症。与前几年相比，GAS菌血症的总发病率增加了近3倍，且这种增加在大龄儿童和30 - 50岁成年人中尤为明显。其他经培养确诊的诊断包括近几十年来不常见的病例，如伴有脓胸的肺炎、坏死性筋膜炎和原发性腹膜炎。对从局部感染中连续收集的菌株进行血清分型显示，T - 1型、不透明因子阴性菌株（T - 1 OF -）占显著优势，从挪威北部的41%到挪威中部的87%不等。M分型证实这些菌株为M - 1型，在所描述时期保存的菌血症菌株中87%也是如此。尽管大多数M - 1菌株明显呈黏液样，但1988年上半年仅报告了1例急性风湿热病例。我们得出结论，挪威发生了由M - 1菌株引起的GAS感染流行，导致疾病发病率和严重程度均有所增加。
