TY - JOUR
T1 - Invasive group a streptococcal disease in The Netherlands
T2 - Evidence for a protective role of anti-exotoxin A antibodies
AU - Mascini, Ellen M.
AU - Jansze, Margriet
AU - Schellekens, Joop F.P.
AU - Musser, James M.
AU - Faber, Joop A.J.
AU - Verhoef-Verhage, Liesbeth A.E.
AU - Schouls, Leo
AU - Van Leeuwen, Wijnanda J.
AU - Verhoef, Jan
AU - Van Dijk, Hans
N1 - Funding Information:
Received 25 January 1999; revised 8 October 1999; electronically published 14 February 2000. All subjects or their relatives gave informed consent to participate in this study. Grant support: Dutch Praeventie Fonds (002824180); NIH (AI-33119). Reprints or correspondence: Dr. Ellen M. Mascini, Eijkman-Winkler Institute for Microbiology, Infectious Diseases, and Inflammation, Utrecht University Hospital G04.614, P.O. Box 85500, NL-3508 GA Utrecht, The Netherlands (E.M.Mascini@lab.azu.nl).
PY - 2000
Y1 - 2000
N2 - 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.
AB - 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.
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U2 - 10.1086/315222
DO - 10.1086/315222
M3 - Article
C2 - 10669348
AN - SCOPUS:0034007268
VL - 181
SP - 631
EP - 638
JO - Journal of Infectious Diseases
JF - Journal of Infectious Diseases
SN - 0022-1899
IS - 2
ER -