Abstract
Six cases of necrotising fasciitis (NF) five confirmed and one probable, caused by group A streptococci (GAS) in residents of Gloucestershire were reported within a three month period in 1994. Two patients died. Two cases were post operative infections which occurred following routine operations within one week. The other cases were thought to be community acquired1. As a result of this cluster of severe infections within one geographic locality a PHLS Action Group was established to discuss strategies and the implications of this incident. The group agreed a case definition for surveillance purposes and recommended that an enhanced programme of surveillance of severe group A streptococcal infections should be set up in England and Wales. This has now been successfully established. Information relating to trends in severe GAS disease at that time did not suggest that there had been a sudden increase in disease. Twenty six cases of GAS necrotising fasciitis were reported in England and Wales with dates of onset during the first six months of 1994. The case fatality rate was 69% However, routine surveillance was unable to provide a precise figure of the number of cases of NF associated with GAS infections in England and Wales prior to the Enhanced Surveillance Scheme. Data from this survey, combined with data from other countries gave estimates of 45 to 120 cases of GAS NF each year. Preliminary analysis of 847 cases of invasive GAS disease during the surveillance period of July 1994 to February 1996 has shown that they included 56 confirmed cases of NF of which 53% of patients had died.
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References
Cartwright K, Logan M, McNulty M, Harrison S, George RC, Efstratiou A, McEvoy M, Begg N. A cluster of cases of streptococcal necrotizing fasciitis in Gloucestershire. Epidemiol Infect 1995;115:387–397.
Cleary PP, Kaplan EL, Handley AW, Kim MH, Hauser AR, Schlievert PM. Clonal basis for resurgence of serious Streptococcus pyogenes disease in the 1980s. Lancet 1992;339:518–521.
Hookey JV, Saunders NA, Clewley JP, Efstratiou A, George RC. Virulence regulon polymorphism in group A streptococci revealed by long PCR and implications for epidemiologiccal and evolutionary studies. J Med Microbiol 1996 (in press).
Musser JM, Gray BM, Schlievert PM, Pichichero ME. Streptococccus pyogenes: characterization of strains by multilocus enzyme genotype, M and T protein serotype and pyrogenic exotoxin gene probing. J Clin Microbiol 1992; 30: 600–603.
Reda KB, Kapur V, Mollick JA, Lamphear JG, Musser JM, Rich RR. Molecular characterization and phylogenetic distribution of the streptococcal superantigen (ssa) from Streptococcus pyogenes. Infect Immun 1994; 62: 1867–1874.
Stanley J, Linton D, Desai M, Efstratiou A, George RC. Molecular subtyping of prevalent M serotypes of Streptococcus pyogenes causing invasive disease. J Clin Microbiol 1995;33:2850–2855.
Upton M, Carter PE, Orange G, Pennington HT. Genetic heterogeneity of M type 3 group A streptococci causing severe infections in Tayside. J Clin Microbiol 1996;34:196–198.
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© 1997 Springer Science+Business Media New York
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Efstratiou, A. et al. (1997). Characterisation of Group A Streptococci from Necrotising Fasciitis Cases in Gloucestershire, United Kingdom. In: Horaud, T., Bouvet, A., Leclercq, R., de Montclos, H., Sicard, M. (eds) Streptococci and the Host. Advances in Experimental Medicine and Biology, vol 418. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-1825-3_23
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DOI: https://doi.org/10.1007/978-1-4899-1825-3_23
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