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Group A Streptococcal Outbreaks in Nursing Homes

Published online by Cambridge University Press:  21 June 2016

Benjamin Schwartz  and
Xilla T. Ussery
Benjamin Schwartz*
Affiliation:
Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, Centers for Disease Control, Atlanta, Georgia
Xilla T. Ussery
Affiliation:
Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, Centers for Disease Control, Atlanta, Georgia
*
Mailstop C-09, Respiratory Diseases Branch, Centers for Disease Control, Atlanta, GA 30333
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Extract

Group A streptococci (Streptococcus pyogenes) are the most common bacterial cause of pharyngitis and a frequent cause of cutaneous infections including impetigo and cellulitis. More rarely, group A streptococci are implicated as the etiologic agent in patients with pneumonia, bacteremia, and a newly described toxic shock-like syndrome.' While invasive group A streptococcal infections occur in persons of all ages, the incidence of these infections is greatest in the elderly, as is the case/fatality ratio. Factors that may contribute to the increased risk of invasive group A streptococcal infections in the elderly include a higher prevalence of underlying illnesses and, possibly, decreased levels of antibodies directed against the group A streptococcal M-protein, a major determinant of virulence.

From the advent of the antibiotic era until the mid-1980s, the occurrence of severe group A streptococcal infections declined. However, since 1985, rheumatic fever outbreaks in civilian and military populations, a syndrome designated the streptococcal toxic shock-like syndrome, and an increased incidence of group A streptococcal bacteremia have been reported. These changes in the epidemiology of group A streptococcal infections have been associated with changes in the serotype distribution, with an increasing proportion of invasive infections caused by M-1 and M-3 strains, and an increase in the proportion of organisms producing pyrogenic exotoxin A, which has been linked to the toxic shock-like syndrome.

Type
Topics in Long-Term Care
Information
Infection Control & Hospital Epidemiology , Volume 13 , Issue 12 , December 1992 , pp. 742 - 747
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1992

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