Okaba Keisuke, Motomura Ayumi, Saito Naoki, Yamaguchi Koji, Ishii Namiko, Hara Shizuru, Ohkusu Misako, Takeuchi Noriko, Ishiwada Naruhiko, Yajima Daisuke
Department of Forensic Medicine, School of Medicine, International University of Health and Welfare, Narita, Japan.
Department of Legal Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.
Int J Legal Med. 2025 Jul 1. doi: 10.1007/s00414-025-03545-8.
Autopsy workers are known to be at risk of contracting various infectious diseases from dead bodies. However, infections caused by group A Streptococcus (GAS, Streptococcus pyogenes) are rarely reported and often overlooked despite their potential severity. GAS infections can lead to serious complications, including streptococcal toxic shock syndrome (STSS). In this study, we conducted genetic analyses to identify the source of GAS bacteremia in a worker who conducted an autopsy on an individual who had developed STSS from GAS. GAS strains from the dead body and autopsy worker were analyzed using polymerase chain reaction (PCR) for five major streptococcal pyrogenic exotoxin (SPE) genes (speA, speB, speC, speF, and ssa) and M protein (emm) typing by sequencing. Multilocus sequence typing (MLST) was performed to analyze seven housekeeping genes (gki, gtr, murI, mutS, recP, xpt, and yqiL) by PCR and sequencing. Both GAS strains were positive for speB and speF, negative for speA, speC, and ssa, and classified as emm81.0 and sequence type 117. This is the first report to demonstrate homology between GAS strains from a dead body and autopsy worker using the M-protein type, SPE gene expression, and MLST analysis. Although the autopsy was conducted in a controlled environment with appropriate personal protective equipment, including N95 masks, GAS contact transmission may have occurred during other handling procedures, such body transportation. These findings emphasize the need for stringent precautionary measures when handling dead bodies and their specimens, considering the risk of infection at any time.
尸检工作人员已知有从尸体感染各种传染病的风险。然而，由A组链球菌（GAS，化脓性链球菌）引起的感染很少被报道，尽管其潜在严重性，但往往被忽视。GAS感染可导致严重并发症，包括链球菌中毒性休克综合征（STSS）。在本研究中，我们进行了基因分析，以确定一名对一名因GAS感染而患上STSS的个体进行尸检的工作人员发生GAS菌血症的来源。使用聚合酶链反应（PCR）对来自尸体和尸检工作人员的GAS菌株进行了五个主要链球菌致热外毒素（SPE）基因（speA、speB、speC、speF和ssa）的分析，并通过测序进行M蛋白（emm）分型。进行多位点序列分型（MLST）以通过PCR和测序分析七个管家基因（gki、gtr、murI、mutS、recP、xpt和yqiL）。两种GAS菌株的speB和speF均为阳性，speA、speC和ssa为阴性，并被分类为emm81.0和序列类型117。这是第一份使用M蛋白类型、SPE基因表达和MLST分析证明来自尸体和尸检工作人员的GAS菌株之间存在同源性的报告。尽管尸检是在包括N95口罩在内的适当个人防护设备的受控环境中进行的，但在其他处理程序（如尸体运输）期间可能发生了GAS接触传播。这些发现强调了在处理尸体及其标本时采取严格预防措施的必要性，要随时考虑到感染风险。
