Severe Streptococcus pyogenes disease in Europe; epidemiology and clinical manifestations

Streptococcus pyogenes, gives rise from mild skin infections and pharyngitis, to life threatening infections like bacteraemia, cellulitis, puerperal sepsis, meningitis, pneumonia, necrotizing fasciitis (NF), and streptococcal toxic-like shock syndrome (STSS), or nonsuppurative sequelae, rheumatic fever and glomerulonephritis.
In 2002, the first multinational network for invasive GAS disease surveillance was initiated by the EU-funded Strep-EURO project. The aim was to create a platform for developing an improved system for surveillance of invasive GAS disease and a laboratory network for epidemiological analysis.
Of total 5522 cases of severe S. pyogenes identified, 4353 isolates were collected. The incidence reached 3/100,000 inhabitants in the northern Europe. The elderly were at higher risk of infection, with higher rates in males than females in most countries. Skin lesions constituted the most prevalent predisposing factor, also the most common focus of infection. The overall case fatality rate was 19%, though much higher among patients with NF and STSS (31% and 44% respectively). The T/emm distribution was highly diverse, with both similarities and striking differences between countries. emm1 was the predominant type in the majority of countries. In Denmark, Finland, and Sweden emm28 was among the most prevalent types. However the Swedish data revealed a change in type distribution, for the first time emm81, and 89 being the most common.
Data collected from Romanian showed a broad type distribution, with unusual types like emm65/69, 92, or 106, seldom isolated in other countries. Through an internal quality control procedure among participating countries the comparability of antibiotic susceptibility data was ascertained.