Volume 29, Number 8—August 2023
Dispatch
Increase of Severe Pulmonary Infections in Adults Caused by M1UK Streptococcus pyogenes, Central Scotland, UK
, Clark D. Russell, Anna-Rose Morgan, Surabhi K. Taori, Diane Lindsay, Roisin Ure, Derek Brown, and Andrew Smith
Table
Characteristics associated with a historical cohort (2017–2022) and a recent epidemic of severe pulmonary infections in adults (2022–23) caused by M1UK Streptococcus pyogenes, central Scotland, UK*
| Characteristic | 2017–2022, GGC only | 2022–2023, GGC and Lothian |
|---|---|---|
| Demographic | ||
| Total no. PiGAS cases | 15 | 38 |
| Median age, y (IQR) | 57 (42.5–66) | 45 (37–63) |
| Sex, no (%) | ||
| M | 13 (87) | 20 (53) |
| F | 2 (6) | 18 (47) |
| Median SIMD score (IQR) |
5 (3.5) |
3 (1–5) |
| Blood parameters at admission | ||
| Median C-reactive protein, mg/L (IQR)† | 293 (198–360) | 328 (172–410) |
| Median leukocyte count, × 109 cells/L (IQR)‡ | 9.5 (3.1–13.7) | 9.45 (4.1–22.1) |
| Median lymphocyte count, × 109 cells/L (IQR)§ |
0.5 (0.3–0.7) |
0.54 (0.31–1.35) |
| Radiographic, no. (%) | ||
| Pleural effusion | 8 (53) | 23 (61) |
| Focal consolidation | 3 (20) | 9 (24) |
| Multifocal consolidation | 11 (73) | 28 (74) |
| Cavitation or necrosis |
2 (13) |
7 (18) |
| Background | ||
| Chronic respiratory disease, no (%) | 7 (47) | 9 (24) |
| Smoker, no (%) | 2 (13) | 10 (26) |
| No past medical history, no (%) | 4 (26.7) | 17 (44.7) |
| Median CCI score (IQR) |
0 (0–3) |
0 (0–3) |
| Viral co-infection | ||
| No. tested | 12 | 33 |
| Influenza A | 1 | 19 |
| Influenza B | 3 | 0 |
| Parainfluenza 1 | 1 | 0 |
| Metapneumovirus | 2 | 4 |
| RSV | 0 | 1 |
| Adenovirus | 0 | 1 |
| None detected |
5 |
8 |
| Outcomes | ||
| ICU admission, no (%) | 8 (53) | 21 (55) |
| Median ICU length of stay, d (IQR) | 5 (2–9.8) | 15 (3.5–27) |
| Vasopressors, no. (%) | 4 (26) | 15 (39) |
| Invasive mechanical ventilation, no. (%) | 7 (46) | 16 (42) |
| Death, no (%) | 3 (20) | 6 (16) |
| Median days from admission to death (IQR) |
1 (1–2) |
1 (0–2) |
| M type | ||
| No. typed | 8 | 25 |
| 1.0 | 3 | 24 |
| 12.0 | 1 | 1 |
| 3.93 | 1 | 0 |
| 44.0 | 1 | 0 |
| 5.23 | 2 | 0 |
*Historical cohort comprises cases identified among the population served by NHS Greater Glasgow and Clyde; cases from the recent epidemic are those identified among populations served by NHS Greater Glasgow and Clyde and NHS Lothian. CCI, Charlson comorbidity index; ICU, intensive care unit; IQR, interquartile range; NHS, National Health Service; PiGAS, pulmonary invasive group A Streptococcus; RSV, respiratory syncytial virus; SIMD, Scottish Index of Multiple Deprivation. †Reference range <5 mg/L. ‡Reference range 4–10 × 109 cells/L. §Reference range 1.1–5.0 × 109 cells/L.