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

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. GAS strains collected in 09/2022-03/2023 in two u...

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Published in:Frontiers in microbiology Vol. 14; p. 1287522
Main Authors: Mangioni, Davide, Fox, Valeria, Saltini, Paola, Lombardi, Andrea, Bussini, Linda, Carella, Francesco, Cariani, Lisa, Comelli, Agnese, Matinato, Caterina, Muscatello, Antonio, Teri, Antonio, Terranova, Leonardo, Cento, Valeria, Carloni, Sara, Bartoletti, Michele, Alteri, Claudia, Bandera, Alessandra
Format: Journal Article
Language:English
Published: Switzerland Frontiers Media S.A 11.01.2024
Subjects:
GAS
genomic surveillance
Microbiology
necrotizing fasciitis
Streptococcus pyogenes
virulence factors
WGS
GAS
Streptococcus pyogenes
WGS
virulence factors
necrotizing fasciitis
genomic surveillance
ISSN:1664-302X, 1664-302X
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Summary: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. 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 types and clinical severity. 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 -types were detected, the most prevalent being 1 and 12 (6/28 strains each, 21.4%). Single nucleotide polymorphism (SNP) analysis of 1.0 and 12.0 strains revealed pairwise SNP distance always >10, inconsistent with unique transmission chains. 12.0-type, found to almost exclusively carry virulence factors H and I, was mainly detected in children and in no-iGAS infections (55.6 vs. 5.3%, = 0.007 and 66.7 vs. 0.0%, < 0.001, respectively), while 1.0-type was mainly detected in severe-iGAS (0.0 vs. 45.5%, = 0.045). This study showed that multiple -types contributed to a 2022/2023 GAS infection increase in two hospitals in Milan, with no evidence of direct transmission chains. Specific -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.
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Edited by: Thomas Proft, The University of Auckland, New Zealand
Mark Davies, The University of Melbourne, Australia
Stephen B. Beres, Houston Methodist Research Institute, United States
These authors have contributed equally to this work and share first authorship
Reviewed by: Luke Blagdon Snell, King's College London, United Kingdom
ISSN:1664-302X
1664-302X
DOI:10.3389/fmicb.2023.1287522