Increase in invasive group A streptococcal infections in Milan, Italy: a genomic and clinical characterization

被引：9

作者：

Mangioni, Davide ^{[1
,2
]}

Fox, Valeria ^{[3
]}

Saltini, Paola ^{[1
,2
]}

Lombardi, Andrea ^{[1
,2
]}

Bussini, Linda ^{[4
,5
]}

Carella, Francesco ^{[4
,5
]}

Cariani, Lisa ^{[6
]}

Comelli, Agnese ^{[1
]}

Matinato, Caterina ^{[6
]}

Muscatello, Antonio ^{[1
]}

Teri, Antonio ^{[6
]}

Terranova, Leonardo ^{[7
,8
]}

Cento, Valeria ^{[5
,9
]}

Carloni, Sara ^{[5
,10
]}

Bartoletti, Michele ^{[4
,5
]}

Alteri, Claudia ^{[3
]}

Bandera, Alessandra ^{[1
,2
]}

机构：

[1] Fdn Ist Ricovero & Cura Carattere Sci IRCCS Ca Gra, Infect Dis Unit, Milan, Italy

[2] Univ Milan, Dept Pathophysiol & Transplantat, Milan, Italy

[3] Univ Milan, Dept Oncol & Hematooncol, Milan, Italy

[4] Ist Ricovero & Cura Carattere Sci IRCCS Humanitas, Infect Dis Unit, Milan, Italy

[5] Humanitas Univ, Dept Biomed Sci, Milan, Italy

[6] Fdn Ist Ricovero & Cura Carattere Sci IRCCS Ca Gra, Microbiol Lab, Clin Pathol, Milan, Italy

[7] Fdn Ist Ricovero & Cura Carattere Sci IRCCS Ca Gra, Dept Internal Med, Resp Unit, Milan, Italy

[8] Fdn Ist Ricovero & Cura Carattere Sci IRCCS Ca Gra, Adult Cyst Fibrosis Ctr, Dept Internal Med, Milan, Italy

[9] Ist Ricovero & Cura Carattere Sci IRCCS Humanitas, Microbiol & Virol, Milan, Italy

[10] Ist Ricovero & Cura Carattere Sci IRCCS Humanitas, Rozzano, Italy

来源：

FRONTIERS IN MICROBIOLOGY | 2024年 / 14卷

关键词：

Streptococcus pyogenes; GAS; necrotizing fasciitis; virulence factors; WGS; genomic surveillance; OUTBREAK; MANAGEMENT;

D O I：

10.3389/fmicb.2023.1287522

中图分类号：

Q93 [微生物学];

学科分类号：

071005 ; 100705 ;

摘要：

Background: Group A Streptococcus (GAS) causes multiple clinical manifestations, including invasive (iGAS) or even life-threatening (severe-iGAS) infections. After the drop in cases during COVID-19 pandemic, in 2022 a sharp increase of GAS was reported globally.Methods; GAS strains collected in 09/2022-03/2023 in two university hospitals in Milan, Italy were retrospectively analyzed. Clinical/epidemiological data were combined with whole-genome sequencing to: (i) define resistome/virulome, (ii) identify putative transmission chains, (iii) explore associations between emm-types and clinical severity.Results: Twenty-eight isolates were available, 19/28 (67.9%) from adults and 9/28 (32.1%) from pediatric population. The criteria for iGAS were met by 19/28 cases (67.9%), of which 11/19 (39.3%) met the further criteria for severe-iGAS. Pediatric cases were mainly non-invasive infections (8/9, 88.9%), adult cases were iGAS and severe-iGAS in 18/19 (94.7%) and 10/19 (52.6%), respectively. Thirteen emm-types were detected, the most prevalent being emm1 and emm12 (6/28 strains each, 21.4%). Single nucleotide polymorphism (SNP) analysis of emm1.0 and emm12.0 strains revealed pairwise SNP distance always >10, inconsistent with unique transmission chains. Emm12.0-type, found to almost exclusively carry virulence factors speH and speI, was mainly detected in children and in no-iGAS infections (55.6 vs. 5.3%, p = 0.007 and 66.7 vs. 0.0%, p < 0.001, respectively), while emm1.0-type was mainly detected in severe-iGAS (0.0 vs. 45.5%, p = 0.045).Conclusions: This study showed that multiple emm-types contributed to a 2022/2023 GAS infection increase in two hospitals in Milan, with no evidence of direct transmission chains. Specific emm-types could be associated with disease severity or invasiveness. Overall, these results support the integration of classical epidemiological studies with genomic investigation to appropriately manage severe infections and improve surveillance.

引用

页数：12

共 64 条

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