Increased prevalence of group A streptococcus isolates in streptococcal toxic shock syndrome cases in Japan from 2010 to 2012

• Published in: Epidemiology and infection Vol. 143; no. 4; pp. 864 - 872
• Main Authors: IKEBE, T., TOMINAGA, K., SHIMA, T., OKUNO, R., KUBOTA, H., OGATA, K., CHIBA, K., KATSUKAWA, C., OHYA, H., TADA, Y., OKABE, N., WATANABE, H., OGAWA, M., OHNISHI, M.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.03.2015
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Clindamycin - pharmacology; Disease control; Drug Resistance, Bacterial - genetics; Erythromycin - pharmacology; Female; Genes; Genotype; Genotype & phenotype; Genotypes; Human subjects; Humans; Infant; Infectious diseases; Japan - epidemiology; Male; Microbial Sensitivity Tests; Middle Aged; Original Papers; Pathogens; Penicillin; Prevalence; Proteins; Shock, Septic - epidemiology; Shock, Septic - microbiology; Streptococcal Infections - epidemiology; Streptococcal Infections - microbiology; Streptococcus; Streptococcus infections; Streptococcus pyogenes - drug effects; Streptococcus pyogenes - genetics; Streptococcus pyogenes - isolation & purification; Toxic shock syndrome; Working groups; Young Adult; Japan; group A streptococcus; emm genotype; streptococcal toxic shock syndrome; Antibiotic resistance
• ISSN: 0950-2688; 1469-4409; 1469-4409
• DOI: 10.1017/S0950268814001265

Streptococcal toxic shock syndrome (STSS) is a severe invasive infection characterized by the sudden onset of shock, multi-organ failure, and high mortality. In Japan, appropriate notification measures based on the Infectious Disease Control law are mandatory for cases of STSS caused by β-haemolytic streptococcus. STSS is mainly caused by group A streptococcus (GAS). Although an average of 60–70 cases of GAS-induced STSS are reported annually, 143 cases were recorded in 2011. To determine the reason behind this marked increase, we characterized the emm genotype of 249 GAS isolates from STSS patients in Japan from 2010 to 2012 and performed antimicrobial susceptibility testing. The predominant genotype was found to be emm1, followed by emm89, emm12, emm28, emm3, and emm90. These six genotypes constituted more than 90% of the STSS isolates. The number of emm1, emm89, emm12, and emm28 isolates increased concomitantly with the increase in the total number of STSS cases. In particular, the number of mefA-positive emm1 isolates has escalated since 2011. Thus, the increase in the incidence of STSS can be attributed to an increase in the number of cases associated with specific genotypes.