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Clinical and epidemiologic features of group a streptococcal
pneumonia in ontario, Canada.
Autor – Muller MP; Low DE;
Green KA; Simor AE; Loeb M; Gregson D; McGeer A
Zeitschrift/Erscheinungsdatum –
Arch Intern Med 2003 Feb 24;163(4):467-72.
STUDY OBJECTIVES:
BACKGROUND: Since the 1960s, group A streptococcus (GAS) has accounted
for less than 1% of cases of community-acquired pneumonia. During the
past 2 decades there has been a resurgence of invasive GAS infection,
but no large study of GAS pneumonia has been performed. METHODS: To determine
the clinical and epidemiologic features of GAS pneumonia, we conducted
prospective, population-based surveillance of all invasive GAS infection
in residents of Ontario from January 1, 1992, through December 31, 1999.
RESULTS: Of 2079 cases of invasive GAS infection, 222 (11%) represented
GAS pneumonia. The incidence of GAS pneumonia ranged from 0.16 per 100
000 in 1992 to 0.35 per 100 000 in 1999. Most cases were community acquired
(81%). Forty-four percent of nursing home-acquired cases occurred during
outbreaks. The case fatality rate was 38% for GAS pneumonia, compared
with 12% for the entire cohort with invasive GAS infection and 26% for
patients with necrotizing fasciitis. The presence of streptococcal toxic
shock syndrome (odds ratio, 19; 95% confidence interval, 8.4-42; P =.001)
and increasing age (odds ratio per decade, 1.45; 95% confidence interval,
1.2-1.7; P<.001) were associated with fatal outcome. Time to death
was rapid, with a median of 2 days despite antimicrobial therapy and supportive
measures. CONCLUSIONS: Group A streptococcal pneumonia is a common form
of invasive GAS disease but remains an uncommon cause of community-acquired
pneumonia. Progression is rapid despite appropriate therapy. The incidence
is similar to, and the case fatality rate higher than, that of necrotizing
fasciitis.
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