Gear R J, Carter J C, Carapetis J R, Baird R, Davis J S
Royal Darwin Hospital, Darwin, NT, Australia.
Trop Med Int Health. 2015 Jan;20(1):40-7. doi: 10.1111/tmi.12405. Epub 2014 Oct 29.
Invasive group A streptococcus (iGAS) disease is an important cause of mortality globally. The incidence of iGAS in Australia's tropical Northern Territory (NT) has been previously reported as 32.2/100 000 in Indigenous people for the period 1991-1996. We aimed to measure the incidence and severity of iGAS disease in the NT since this time.
We collected demographic data for all GAS blood culture isolates over a 12-year period (1998-2009) from the three hospital laboratories serving the tropical NT. We then collected detailed clinical information from hospital records and databases for the subset of these patients who were admitted to Royal Darwin Hospital during 2005-2009.
There were 295 confirmed cases of GAS bacteraemia over the study period, with a mean (SD) age of 42.1 (22.0) years, and 163 (55.0%) were male. The annual age-adjusted incidence was 15.2 (95% CI 13.4-16.9)/100 000 overall and 59.4 (95% CI 51.2-67.6) in Indigenous Australians. For 2005-2009, there were 123 cases with the most common focus of infection being skin/soft tissue [44 (35.6%)]; 29 patients (23.6%) required intensive care unit admission and 20 (16.3%) had streptococcal toxic shock syndrome. Antecedent sore throat or use of non-steroidal anti-inflammatory drugs was rare, but current or recent scabies, pyoderma and trauma were common.
The incidence and severity of iGAS are high and increasing in tropical northern Australia, and urgent attention is needed to improve surveillance and the social determinants of health in this population. This study adds to emerging data suggesting increasing importance of iGAS in low- and middle-income settings globally.
侵袭性A组链球菌（iGAS）疾病是全球死亡的重要原因。此前报告称，1991 - 1996年期间，澳大利亚热带地区北领地（NT）原住民中iGAS的发病率为32.2/10万。我们旨在测定自那时起NT地区iGAS疾病的发病率和严重程度。
我们收集了12年期间（1998 - 2009年）为热带NT地区服务的三家医院实验室所有A组链球菌血培养分离株的人口统计学数据。然后，我们从医院记录和数据库中收集了2005 - 2009年期间入住达尔文皇家医院的这些患者子集的详细临床信息。
在研究期间，共有295例确诊的A组链球菌菌血症病例，平均（标准差）年龄为42.1（22.0）岁，其中163例（55.0%）为男性。总体年龄调整后的年发病率为15.2（95%置信区间13.4 - 16.9）/10万，澳大利亚原住民为59.4（95%置信区间51.2 - 67.6）/10万。2005 - 2009年期间，有123例病例，最常见的感染部位是皮肤/软组织[44例（35.6%）]；29例患者（23.6%）需要入住重症监护病房，20例（16.3%）患有链球菌中毒性休克综合征。前驱咽痛或使用非甾体类抗炎药很少见，但当前或近期的疥疮、脓疱病和外伤很常见。
在澳大利亚北部热带地区，iGAS疾病的发病率和严重程度很高且呈上升趋势，需要迫切关注以改善该人群的监测和健康的社会决定因素。这项研究补充了新出现的数据，表明iGAS在全球中低收入环境中的重要性日益增加。
