Invasive group A streptococcal disease in the Netherlands: evidence for a protective role of anti-exotoxin A antibodies

J Infect Dis. 2000 Feb;181(2):631-8. doi: 10.1086/315222.

Abstract

As part of a nationwide surveillance in The Netherlands during 1994-1997, 53 patients with invasive group A streptococcal (GAS) infections were evaluated for medical history, symptoms, and outcome. Patients' isolates were tested for the production of pyrogenic exotoxins A (SPE-A) and B (SPE-B). Acute-phase sera from all patients and convalescent sera from 12 patients were investigated for the presence of antibodies against SPE-A and SPE-B. Twenty-three patients developed toxic shock-like syndrome and 16 died. Absence of antibodies against SPE-A and/or SPE-B was a risk factor for developing invasive streptococcal disease. Toxic shock and mortality were associated with a lack of anti-SPE-A antibodies (P<.025). Anti-SPE-A antibodies were found in convalescent sera from all patients infected by speA-positive isolates. Virtually all invasive speA-positive streptococci expressed SPE-A protein in vitro. Thus antibodies against SPE-A appeared vital for mediating the outcome of invasive GAS disease in this population.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antibodies, Bacterial / blood*
  • Antibodies, Bacterial / immunology
  • Bacteremia / diagnosis
  • Bacteremia / epidemiology
  • Bacteremia / microbiology
  • Bacterial Proteins*
  • Child
  • Child, Preschool
  • Enzyme-Linked Immunosorbent Assay
  • Exotoxins / biosynthesis
  • Exotoxins / immunology*
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Membrane Proteins*
  • Middle Aged
  • Netherlands / epidemiology
  • Population Surveillance
  • Prognosis
  • Shock, Septic / diagnosis
  • Shock, Septic / epidemiology
  • Shock, Septic / microbiology
  • Streptococcal Infections / diagnosis
  • Streptococcal Infections / epidemiology
  • Streptococcal Infections / immunology*
  • Streptococcal Infections / microbiology*
  • Streptococcus pyogenes / isolation & purification*
  • Streptococcus pyogenes / metabolism

Substances

  • Antibodies, Bacterial
  • Bacterial Proteins
  • Exotoxins
  • Membrane Proteins
  • SpeA protein, Streptococcus pyogenes
  • erythrogenic toxin