Journal Article

Invasive Group A Streptococcal Disease in Metropolitan Atlanta: A Population-Based Assessment

Christine A. Zurawski, MarySusan Bardsley, Bernard Beall, John A. Elliott, Richard Facklam, Benjamin Schwartz and Monica M. Farley

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 27, issue 1, pages 150-157
Published in print July 1998 | ISSN: 1058-4838
Published online July 1998 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/514632
Invasive Group A Streptococcal Disease in Metropolitan Atlanta: A Population-Based Assessment

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Active, population-based surveillance for invasive group A streptococcal (GAS) disease was conducted in laboratories in metropolitan Atlanta from 1 January 1994 through 30 June 1995. Clinical and laboratory records were reviewed and isolates characterized. One hundred and eighty-three cases of invasive GAS disease were identified (annual incidence, 5.2 cases/100,000). The incidence was highest among blacks (9.7/100,000 per year; relative risk (RR), 1.92; confidence interval (CI), 1.69–2.19; P < .0001) and the elderly, particularly nursing home residents (RR, 13.66; CI, 7.07–26.40; P < .0001). The mean age of patients was 41.3 years (range, 0–95 years). Skin and soft-tissue infections were most common. Mortality was 14.4%; risk of death was significantly higher for patients with streptococcal toxic shock syndrome (STSS) (RR, 9.73; CI, 3.34–29; P = .0008) and individuals infected with M-type 1 (RR, 7.40; CI, 1.5–16; P = .0084). Fourteen percent of invasive GAS infections were STSS and 3% were necrotizing fasciitis. Invasive GAS disease was associated with varicella infection in children (RR, 12.19; CI, 5.58–26.62; P < .0001). M (or emm) types included M1 (16%), M12 (12%), and M3 (11%). Continued study of GAS disease is essential to further define risk factors and the risk of secondary cases and to develop effective prevention strategies.

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Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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