Clinical and Microbiological Characteristics of Severe Streptococcus pyogenes Disease in Europe.

In an attempt to compare the epidemiology of severe S. pyogenes infection within Europe, prospective data were collected through the Strep-EURO programme. Surveillance of severe S. pyogenes infection diagnosed during 2003 and 2004 was undertaken in eleven countries across Europe using a standardised case definition and questionnaire. Patient data as well as bacterial isolates were collected and characterized by T- and, M/emm-typing and selected strains were analysed for presence of superantigen genes. Data were analysed to compare the clinical and microbiological patterns of infections across participating countries. Totally 4353 isolates were collected from 5521 cases with severe S. pyogenes infection identified. It was wide diversity of M/emm-types (104) found among the S. pyogenes clinical isolates but M/emm-type distribution varied broadly between participating countries. The ten most predominant M/emm-types were 1, 28, 3, 89, 87, 12, 4, 83, 81, and 5 in descending order. A correlation was found between some specific disease manifestation, age of patients and emm-types. Streptococcal toxic shock syndrome and necrotizing fasciitis, although caused by a large number of types, were particularly associated with M/emm-types 1 and 3. The emm-types included in the 26-valent vaccine under development, were generally well represented in the presentmaterial; 16 of the vaccine types accounted for 69% of isolates. The Strep-EURO collaborative programme has contributed to enhance the knowledge on the spread of invasive disease caused by S. pyogenes within Europe and encourage future surveillance with notification of cases and characterisation of strains, important for vaccine strategies and other health care issues.