CLINICO – MICROBIOLOGICAL STUDY OF INVASIVE GROUP A STREPTOCOCCAL (GAS) DISEASE IN SOUTHERN INDIA

Sangeetha Mohan; J John Melbin Jose; Reena Rajkumari; Ismath Jahan; K N Brahmadathan

Volume : IX, Issue : V, May - 2019

CLINICO – MICROBIOLOGICAL STUDY OF INVASIVE GROUP A STREPTOCOCCAL (GAS) DISEASE IN SOUTHERN INDIA

Sangeetha Mohan, J John Melbin Jose, Reena Rajkumari, Ismath Jahan, K N Brahmadathan

Abstract :

Group A streptococcal (GAS) associated–disease and sequalae are a significant public health concern in India, contributing to high morbidity and mortality in children and young adults. Despite their widespread prevalence, comprehensive data on incidence and endemicity of infections of invasive GAS disease across the country is lacking. The need for extensive GAS epidemiological data is vital to the effective prevention and management of streptococcal disease in India. The following study conducted over a period of five years, at CMC Vellore, correlates the microbiological and clinical aspects of the disease as seen in this tertiary care center in southern India. This is intended to provide useful information to clinicians as well as microbiologists especially for those who are concerned with the management and control of GAS disease in India. BACKGROUND: Invasive group A streptococcal disease has attracted much attention globally for several decades; however, despite the endemicity of streptococcal infections, its reported literature from India is scanty. AIM: This study was undertaken to describe the clinical and microbiological aspects of streptococcal invasive disease among patients seen in a south Indian tertiary care center and identify measures to control them. MATERIALS AND METHODS: Fifty seven group A streptococci recovered from an equal number of patients were selected for the study. Invasive streptococcal disease was defined by the isolation of group A streptococci from sterile body sites with diverse clinical signs and symptoms. Isolates were subjected to emm typing by an automated gene sequencing method and analyzed in relation to the demographic / clinical details of patients and outcome of their management. RESULTS: Highest incidence was found among elderly patients (26.3%) followed by neonates (21%). Thirty four (59.6%) were blood isolates and 31 (54.3%) had underlying conditions such as diabetes mellitus and malignancy (12.3% each). Forty two emm types were identified among 57 isolates with types 63, 74, 85 and 110 accounting for 21.05 %; one type was a hitherto unrecognized. There was no association of any type with particular clinical condition. Thirteen of the 55 patients expired of whom nine had underlying conditions. Twelve different emm types were associated with them. CONCLUSION: Close clinical and laboratory monitoring of patients especially neonates and elderly patients with underlying conditions is necessary to identify and control severe group A streptococcal invasive disease in regions endemic to group A streptococcal infection.