Invasive Streptococcus pyogenes infection: a case report

  1. Samia Bazhar
  2. Yassine ElBenaissi
  3. Elmostafa Benaissa
  4. Yassine Ben Lahlou
  5. Mariama Chadli

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Abstract

The Group A Streptococcus (GAS), also known as Streptococcus pyogenes ( S. pyogenes ), is a human pathogen causing various infections, ranging from mild, such as tonsillitis and impetigo, to severe and invasive conditions like septicemia and necrotizing fasciitis. Despite a decline in incidence and severity during the twentieth century due to antibiotics, there has been a reported increase in severe cases since the 1980s in industrialized countries. S. pyogenes is a human pathogen with a natural reservoir in the pharynx and skin, exhibits asymptomatic carriage in various body sites. It is responsible for a spectrum of clinical manifestations, from asymptomatic carriage to severe invasive infections. Transmission occurs through respiratory droplets or direct contact with skin lesions. Bacteriologically, S. pyogenes is a Gram-positive β-hemolytic streptococcus. This summary highlights a case of invasive Group A Streptococcus infection in a 28-year-old diagnosed at the microbiology laboratory of the Mohammed V Military Training Hospital in Rabat, Morocco. A 28-year-old patient, without any specific medical history, presented with acute febrile oligoarthritis. Following a recent flu-like syndrome and febrile tonsillitis, the patient experienced asymmetric inflammatory oligoarthralgia affecting the left knee, left ankle, and right shoulder, accompanied by functional impairment of the left lower limb. Upon admission, clinical examination revealed swelling, positive patellar tap, and sternal involvement. Laboratory and imaging findings indicated an abscessed collection in the left knee and anterior mediastinitis. Emergency aspirations revealed Group A Streptococcus, specifically Streptococcus pyogenes , leading to a diagnosis of septic arthritis. Dual antibiotic therapy and knee joint drainage resulted in symptom resolution after 45 days. The rise in severe Group A Streptococcus infection underscores the need for early detection and treatment. Widely sharing the French High Council for Public Health’s antibiotic prophylaxis recommendations is crucial for awareness. Collaborating between clinicians and microbiologists is essential for effective management.

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  1. Version published to 10.1099/acmi.0.000767.v3 on Access Microbiology
  3. Access Microbiology

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    I am satisfied with the corrections that the authors did to the manuscript, taking into account the reviewers comments and, therefore, I recommend the publication of the manuscript without further modifications.

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  5. Version published to 10.1099/acmi.0.000767.v2 on Access Microbiology
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    This study would be a valuable contribution to the existing literature. The reviewers have highlighted major concerns with the work presented. Please ensure that you address their comments.

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    Comments to Author

    1. Please elaborate the methods used for identification / grouping of Streptococcus? 2. It is stated that the Antimicrobial susceptibility testing was done using diffusion method (as per EUCAST), however the sensitivity profile table shows MIC values which cannot be obtained from the agar diffusion methods. Also, there are few discrepancies in the interpretation - for eg. as per EUCAST 2013, breakpoint MIC for tertacycline is 4ug/ml and 1ug/ml of the isolate is reported as sensitive. Similarly, Breakpoint is not available for Gentamycine in EUCAST 2013.

    Please rate the quality of the presentation and structure of the manuscript

    Satisfactory

    To what extent are the conclusions supported by the data?

    Partially support

    Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?

    No

    Is there a potential financial or other conflict of interest between yourself and the author(s)?

    No

    If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?

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  8. Access Microbiology

    Comments to Author

    The authors describe a case report of invasive Streptococcus pyogenes infection that established the diagnosis of septic arthritis. This study should represent a good addition to the literature. In general, there are adjustments necessary in the manuscript, including in the case presentation and discussion. For the above reasons, it can be accepted for publication in the Access Microbiology after revision. Note: No extensive grammar corrections were performed in the text. Please, ensure that the proper language used in all text is corrected and extensively verified by professional English editing services before being taken for publication. Please verify the following: 1. Add italics to the bacteria name mentioned, including when abbreviated. For example: line 29, line 44, line 53, line 176. 2. Line 59. Inform in the introduction about the importance of Streptococcus pyogenes in multisystem inflammatory diseases such as rheumatic fever or septic arthritis, which is related to the case analysed here. 3. Line 75. Would it be necessary to mention chickenpox? Because it seems to have no relation to the case analyzed. Check this. 4. Line 78. Inform the treatment previously carried out, if you have this information. 5. Line 83. If the patient used any medication during this period, describe it. 6. Line 85. Describe the acronym "GCS" when it is the first time it is mentioned. 7. Line 140. Describe which technique was used in the mediastinal aspirations procedure. 8. Line 146. Inform the technique and staining performed to microscopy identify of the species, and inform if there was any biochemical identification. 9. Line 150. Describe better the legend of Figure 4. To explain what magnification and coloring are used in the microscopy image, for example. 10. Line 170. The flu-like syndrome and febrile tonsillitis that affects the patient a month before hospitalization may be related to the clinical finding and therefore should be discussed. 11. Line 170. Describe better about the relationship between streptococcal infection and septic arthritis. 12. Line 183 to 187. These informations should appear in the introduction and not in the discussion of the case. 13. Line 213. I didn't understand this statement "the use of an oral macrolide (as in our case..." 14. Standardize references and figures citation with the journal's standards.

    Please rate the quality of the presentation and structure of the manuscript

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    Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?

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    Is there a potential financial or other conflict of interest between yourself and the author(s)?

    No

    If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?

    Yes

  9. Version published to 10.1099/acmi.0.000767.v1 on Access Microbiology