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

Ellen M. Mascini, Margriet Jansze, Joop F.P. Schellekens, James M. Musser, Joop A.J. Faber, Liesbeth A.E. Verhoef-Verhage, Leo Schouls, Wijnanda J. Van Leeuwen, Jan Verhoef, Hans Van Dijk

Research output: Contribution to journalArticle

42 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)631-638
Number of pages8
JournalJournal of Infectious Diseases
Volume181
Issue number2
DOIs
StatePublished - Mar 15 2000

ASJC Scopus subject areas

  • Immunology and Allergy
  • Infectious Diseases

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