Hoge C W, Schwartz B, Talkington D F, Breiman R F, MacNeill E M, Englender S J
Respiratory Diseases Branch, Center for Infectious Diseases, National Centers for Disease Control and Prevention, Atlanta, Ga.
JAMA. 1993 Jan 20;269(3):384-9.
To determine disease incidence and changes in the epidemiology of invasive group A streptococcal infections in a community in Arizona.
We retrospectively surveyed microbiology records from all 10 hospitals in Pima County, Arizona, to identify patients who had Streptococcus pyogenes isolated from blood, sterile body fluid, or tissue biopsy specimens between April 1985 and March 1990. Demographic and clinical information was abstracted from the medical records of these patients.
A total of 128 patients with a median age of 53.5 years (range, 6 months to 96 years).
Racial/ethnic differences in disease incidence; mortality and changes in the clinical spectrum of disease over the study period.
The annual age-adjusted incidence was 4.3 per 100,000 but was 46.0 per 100,000 among Native Americans. Advanced age, age less than 5 years, hypotension, and multi-organ system involvement were significantly associated with increased mortality. From 1985 to 1990, the proportion of infections with hypotension, rash, desquamation, renal impairment, and gastrointestinal involvement increased significantly (chi 2 for trend P < or = .02 for each feature). A toxic shock-like syndrome occurred in 8% of infections since 1988, compared with none of the infections between 1985 and 1987 (P = .04). Patients with the syndrome were younger than patients with other invasive infections (median age 15 vs 54 years, P = .02), and were less likely to have underlying medical conditions (P = .008).
Significant changes occurred in the spectrum of invasive group A streptococcal infections in Pima County, Arizona, between 1985 and 1990. Native Americans were at increased risk of acquiring these infections. Patients with the streptococcal toxic shock-like syndrome had epidemiologic features that distinguished them from patients with other invasive infections, including younger age and less underlying illness.
确定亚利桑那州一个社区侵袭性A组链球菌感染的疾病发病率及流行病学变化。
我们回顾性调查了亚利桑那州皮马县所有10家医院的微生物学记录，以确定1985年4月至1990年3月期间从血液、无菌体液或组织活检标本中分离出化脓性链球菌的患者。人口统计学和临床信息从这些患者的病历中提取。
共128例患者，中位年龄53.5岁（范围6个月至96岁）。
疾病发病率的种族/民族差异；死亡率以及研究期间疾病临床谱的变化。
年龄调整后的年发病率为每10万人4.3例，但美洲原住民中为每10万人46.0例。高龄、5岁以下、低血压和多器官系统受累与死亡率增加显著相关。从1985年到1990年，伴有低血压、皮疹、脱皮、肾功能损害和胃肠道受累的感染比例显著增加（各特征趋势的卡方检验P≤0.02）。自1988年以来，8%的感染发生了中毒性休克样综合征，而1985年至1987年期间的感染均未出现该综合征（P = 0.04）。患有该综合征的患者比其他侵袭性感染患者年轻（中位年龄15岁对54岁，P = 0.02），且合并基础疾病的可能性较小（P = 0.008）。
1985年至1990年期间，亚利桑那州皮马县侵袭性A组链球菌感染的临床谱发生了显著变化。美洲原住民感染这些疾病的风险增加。患有链球菌中毒性休克样综合征的患者具有与其他侵袭性感染患者不同的流行病学特征，包括年龄较小和基础疾病较少。
