From the Microbiology Department, Donostia University Hospital-Biodonostia Health Research Institute, Donostia-San Sebastian.
Molecular Microbiology Department, Institut de Recerca Sant Joan de Déu, Sant Joan de Déu University Hospital, Barcelona.
Pediatr Infect Dis J. 2019 Dec;38(12):1168-1172. doi: 10.1097/INF.0000000000002471.
To perform a comprehensive description of the epidemiology of Streptococcus pyogenes invasive disease in the pediatric population in 2 regions of Spain (Catalonia and Gipuzkoa) through 12 years.
All S. pyogenes isolates causing invasive disease in pediatric patients between 2005 and 2016 were included. The emm-type and the presence of 13 exotoxin genes (speA, speB, speC, speF, speG, speH, speI, speJ, speK, speL, speM, smeZ, ssa and slo) were determined in all 93 available isolates and the Multi Locus Sequece Typing in 10% of isolates of each different emm-type.
Overall, 103 cases of S. pyogenes invasive infections were detected: 77 in Catalonia and 26 in Gipuzkoa, being 50.5% females. The incidence rate per 100,000 children was 2.5 for Gipuzkoa and 2.6 for Catalonia, with no significant temporal trends. The median age was 30 months. The most frequent clinical presentations were: pneumonia (26.2%), bacteremia/sepsis (23.3%), septic arthritis/osteomyelitis (22.3%), cellulitis/mastoiditis (12.6%) and meningitis (6.8%). Eight children developed streptococcal toxic shock syndrome. Nine cases were preceded by varicella infection. The associated mortality rate was 3.9%. Three isolates were resistant to erythromycin, being one of them also resistant to clindamycin and 4 isolates were resistant to levofloxacine. Forteen different emm-types were detected being emm1/ST28 (40.9%) the most frequent clone in both regions followed by emm12/ST36-ST242, emm6/ST382, emm3/ST15, emm75/ST150 and emm4/ST38-39. speA gene was only detected in emm1 and emm3 isolates. Eight exotoxins were enough to assign an emm-type with a very high degree of accuracy (95%). The 30-valent vaccine would include 96.8% of isolates.
通过 12 年时间，在西班牙的加泰罗尼亚和吉普斯夸两个地区全面描述化脓性链球菌侵袭性疾病在儿科人群中的流行病学情况。
纳入 2005 年至 2016 年期间导致儿科侵袭性疾病的所有化脓性链球菌分离株。在 93 株可利用的分离株中确定 emm 型和 13 种外毒素基因（speA、speB、speC、speF、speG、speH、speI、speJ、speK、speL、speM、smeZ 和 ssa）的存在情况，并对每种不同 emm 型的 10%分离株进行多位点序列分型。
共发现 103 例化脓性链球菌侵袭性感染病例：加泰罗尼亚 77 例，吉普斯夸 26 例，女性占 50.5%。吉普斯夸每 100,000 名儿童发病率为 2.5，加泰罗尼亚为 2.6，无显著时间趋势。中位年龄为 30 个月。最常见的临床表现为：肺炎（26.2%）、菌血症/败血症（23.3%）、化脓性关节炎/骨髓炎（22.3%）、蜂窝织炎/乳突炎（12.6%）和脑膜炎（6.8%）。8 例患儿发生链球菌中毒性休克综合征。9 例患儿发病前有带状疱疹感染。相关死亡率为 3.9%。3 株分离株对红霉素耐药，其中 1 株对克林霉素耐药，4 株对左氧氟沙星耐药。共检测到 14 种不同的 emm 型，emm1/ST28（40.9%）是两个地区最常见的克隆，其次是 emm12/ST36-ST242、emm6/ST382、emm3/ST15、emm75/ST150 和 emm4/ST38-39。speA 基因仅在 emm1 和 emm3 分离株中检出。8 种外毒素足以高度准确地确定 emm 型（95%）。30 价疫苗将涵盖 96.8%的分离株。
